Osteopathic Considerations for Peripheral Neuropathy Due to Concomitant Diffuse Idiopathic Skeletal Hyperostosis Syndrome and Lumbar Epidural Lipomatosis: Case Report.

Justin Chin,Christine Lomiguen,Bina Kviatkovsky

doi:10.2196/14607

Abstract

BackgroundDiffuse idiopathic skeletal hyperostosis (DISH) syndrome and lumbar epidural lipomatosis are relatively asymptomatic neurological conditions, with findings often seen incidentally on radiological studies.ObjectiveThe aim of this paper is to present unique findings of concomitant, symptomatic DISH syndrome and lumbar epidural lipomatosis and to discuss the osteopathic diagnosis and treatment implications.MethodsConcomitant, symptomatic variants are rare and present challenges to treatment and management, as seen with a 60-year-old African American woman who presented with worsening disequilibrium and new-onset bilateral fingertip numbness. Past medical history was significant for alcohol abuse disorder, hypertension, hyperlipidemia, and multiple episodes of self-resolving vertigo and lower extremity neuropathy.ResultsThe patient was referred to the neurology department for stroke workup, which was negative. Osteopathic structural exam revealed thoracolumbar and sacral dysfunctions. Magnetic resonance imaging revealed findings consistent with thoracic DISH syndrome and lumbar epidural lipomatosis in the areas of somatic dysfunctions.ConclusionsDue to minimal information on osteopathic manipulative treatment in rare neurological diseases, only gentle techniques of myofascial release, balanced ligamentous tension, and muscle energy were performed with resultant minimal improvement, thus highlighting the necessity for better guidelines and further research.

Highlights

Neurological symptoms are notoriously nonspecific, with differentials ranging from primary causes such as a tumor to secondary causes of dysfunction in other body systems
With considerable overlap in epidemiology, pathogenesis, and treatment options for various neurological diseases and syndromes of exclusion, patients often spend much of their time searching for a panacea, leading to endless frustration and delayed diagnosis/treatment
With no reports of concomitant, symptomatic disseminated idiopathic skeletal hyperostosis (DISH) syndrome and lumbar epidural lipomatosis, the aim of this paper is to present these unique findings and discuss the osteopathic diagnosis and treatment implications

Summary

Introduction

Neurological symptoms are notoriously nonspecific, with differentials ranging from primary causes such as a tumor to secondary causes of dysfunction in other body systems. One-third of all neurological patients have findings that can only be partially or not at all explained by a discrete, organic disease [1]. Psychosocial and other external factors play a role in neurological symptoms and disease manifestation [1,2]. With considerable overlap in epidemiology, pathogenesis, and treatment options for various neurological diseases and syndromes of exclusion, patients often spend much of their time searching for a panacea, leading to endless frustration and delayed diagnosis/treatment. Diffuse idiopathic skeletal hyperostosis (DISH) syndrome and lumbar epidural lipomatosis are relatively asymptomatic neurological conditions, with findings often seen incidentally on radiological studies

Methods

Results

Conclusion