Abstract
ABSTRACTDiffuse idiopathic skeletal hyperostosis (DISH) is often theorized to be an ossification of the anterior longitudinal ligament (ALL). Using computed tomography (CT) imaging and cryomacrotome sectioning, we investigated the spatial relationship between the ALL and newly formed bone in DISH to test this hypothesis. In the current study, four human cadaveric spines diagnosed with DISH using CT imaging were frozen and sectioned using a cryomacrotome. Photographs were obtained of the specimen at 125 µm intervals. Manual segmentations of the ALL on cryomacrotome photographs were projected onto the three‐dimensional reconstructed CT scans. The presence and location of newly formed bone were assessed in relationship to the location of the ALL. The ALL could be identified and segmented on the photographs at all levels. The ALL was located at the midline at levels where no new bone had formed. At the locations where new bone had abundantly formed, the ALL was displaced towards to the contralateral side and not replaced by bony tissue. The displacement of the—morphologically normal appearing—ALL away from the newly formed bone implies that newly formed bone in DISH may not originate from the ALL. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 36:2491–2496, 2018.
Highlights
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition defined as bridging ossifications over at least four contiguous vertebral bodies at the anterolateral spine according to the criteria of Resnick and Niwayama (Fig. 1).[1,2] The prevalence of DISH has been described to range between 2.9% and 42.0% depending on the classification criteria used and presence of risk factors in the studied population.[1,3] DISH is associated with older age, male gender, obesity, diabetes mellitus, and hypertension.[4]
The aim of this study was to investigate the hypothesis that DISH starts as an aberrant/ degenerative ossification of the anterior longitudinal ligament (ALL) by examining the spatial relationship between the ALL and the newly formed bone in human cadaveric spines with DISH using a combination of computed tomography (CT) imaging and cryomacrotome sectioning
We concluded that new bone and ALL were simultaneously present in all four cadaveric spines with DISH
Summary
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition defined as bridging ossifications over at least four contiguous vertebral bodies at the anterolateral spine according to the criteria of Resnick and Niwayama (Fig. 1).[1,2] The prevalence of DISH has been described to range between 2.9% and 42.0% depending on the classification criteria used and presence of risk factors in the studied population.[1,3] DISH is associated with older age, male gender, obesity, diabetes mellitus, and hypertension.[4]. Several authors have suggested the newly formed bone in DISH to be equivalent to, or originate from, ossification/calcification of the ALL.[5,6,7,8,9] the predilection of the new bone to grow. Journal of Orthopaedic Research[1] Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society laterally of the midline suggests that the ALL may not be the (exclusive) origin of newly formed bone in DISH, or may not ossify at all. The aim of this study was to investigate the hypothesis that DISH starts as an aberrant/ degenerative ossification of the ALL by examining the spatial relationship between the ALL and the newly formed bone in human cadaveric spines with DISH using a combination of computed tomography (CT) imaging and cryomacrotome sectioning
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