Cervical Diffuse Idiopathic Skeletal Hyperostosis Research Articles

Prognosis of Cervical Diffuse Idiopathic Skeletal Hyperostosis-Related Spine Injuries in Elderly Patients: Analyses of Both Fracture and Spinal Cord Injury Without Fracture.

Retrospective multicenter study. The purpose of this study was to compare the prognosis of elderly patients with injuries related to cervical diffuse idiopathic skeletal hyperostosis (cDISH) to matched control for each group, with and without fractures. The current multicenter study was a retrospective analysis of 140 patients aged 65years or older with cDISH-related cervical spine injuries; 106 fractures and 34 spinal cord injuries without fracture were identified. Propensity score-matched cohorts from 1363 patients without cDISH were generated and compared. Logistic regression analysis was performed to determine the risk of early mortality for patients with cDISH-related injury. Patients with cDISH-related injuries with fracture did not differ significantly in the incidence of each complication and ambulation or severity of paralysis compared to matched controls. In patients with cDISH-related injury without fracture, those who were nonambulatory at discharge comprised 55% vs 34% of controls, indicating significantly poorer ambulation in those with cDISH-related injuries (P = .023). There was no significant difference in the incidence of complications and ambulation or paralysis severity at 6months as compared with controls. Fourteen patients died within 3months. Logistic regression analysis identified complete paralysis (odds ratio [OR] 36.99) and age (OR 1.24) as significant risk factors for mortality. The current study showed no significant differences in the incidence of complications, ambulation outcomes between patients with cDISH-related injury with fracture and matched controls, and that the ambulation at discharge for patients with cDISH-related injury without fractures were significantly inferior to those of matched controls.

A Single-Center, Cross-Sectional Prevalence Study of Cervical Diffuse Idiopathic Skeletal Hyperostosis

Introduction: In this study, we aimed to investigate the prevalence and characteristics of cervical diffuse idiopathic skeletal hyperostosis using computed tomography scans of the cervical vertebra. Materials and Methods: This study was performed using the Picture Archiving and Communication System of our hospital. Computed tomography images of 1744 patients were included in this study. The patients were divided into age groups by decade. The characteristics of the cervical osteophytes and intervertebral bridging were recorded. Cervical diffuse idiopathic skeletal hyperostosis was diagnosed based on the criteria described by Resnick and Niwayama. Results: The mean age of the study group was 48 years. The prevalence rate of cervical diffuse idiopathic skeletal hyperostosis was 6.3% (6.4% in males and 6.2% in females). The difference between genders was not statistically significant (p=0.908). The prevalence rates significantly increased as age increased. The prevalence rate of cervical osteophytes was 36.5% (33.9% in males and 40.6% in females). The most frequently affected level was C5-6 (16.9%), and the vertebra was C6 (30.6%). Osteophytes were localised in the midline with a rate of 75.5% and was most frequently found in the 70–79 age group (81.2%). Conclusion:In our study, we detected the prevalence rates of cervical diffuse idiopathic skeletal hyperostosis and cervical osteophytes, which were 6.3% and 36.5%, respectively. In comparison, the most frequently affected vertebra and intervertebral levels were, respectively, C6 (30.6%) and C5-6 (16.9%), and cervical osteophytes was most often formed in the midline (75.5%). Keywords: Geriatrics; Hyperostosis, Diffuse Idiopathic Skeletal; Prevalence; Cervical Vertebrae; Osteophyte.

Operative Outcomes After Cervical Diffuse Idiopathic Skeletal Hyperostosis Fracture in the Elderly.

Cervical diffuse idiopathic skeletal hyperostosis (DISH) fractures are frequently unstable and carry significant risk of neurologic injury and death. Most patients with DISH fractures are elderly (>70 years) with significant comorbidities. We assessed factors that contribute to outcomes in elderly patients with cervical DISH fractures. Elderly patients with cervical DISH fractures from 2008 to 2017 were included in this retrospective multi-institutional cohort study. Predictor variables included injury level, surgical approach, preinjury comorbidities, American Society of Anesthesiologists (ASA) score, American Spinal Injury Association (ASIA) impairment scale grade, preoperative anticoagulation status, and the subaxial cervical spine injury classification system (SLIC) score. Univariate and multivariate analyses were utilized to identify factors associated with 30-day mortality and ambulatory status at discharge. A total of 48 patients, mean age 74.7 years old (range 60-96), underwent cervical fixation for DISH fractures. Average SLIC score was 6.30 ± 1.2 (range 5-8), and most frequent fracture level was at C6 to -C7 (31.3%) followed by C7-T1 (25.0%). Forty (83.3%) patients underwent posterior fixation, 7 (14.6%) with anterior fixation, and 1 (2.1%) had combined approach. Ten (20.4%) patients died within 30 days of surgery. Multivariate analysis demonstrated that poorer preoperative ASIA grade (OR 2.35, P = 0.003, CI = 1.33-4.14) and ASA score >3 (P = 0.027) had increased risk of being nonambulatory at discharge. Higher SLIC score was associated with increased 30-day mortality (P = 0.021, CI = 1.20-9.60). Cervical DISH fractures can be highly unstable, for which instrumentation and fixation are indicated. Surgical decision-making should focus on preoperative ASIA grade, SLIC score, and ASA score. The study is relevant due to an aging poulation predisposed to cervical DISH fractures.

Progressive upper airway stenosis secondary to cervical diffuse idiopathic skeletal hyperostosis manifested by aspiration

Progressive upper airway stenosis secondary to cervical diffuse idiopathic skeletal hyperostosis manifested by aspiration

Improvement of Swallowing Function After Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis: Our Experience

To investigate the swallowing improvement in patients who underwent a transcervical prevascular retrovisceral approach for symptomatic cervical diffuse idiopathic skeletal hyperostosis (DISH), by means of the 10-item Eating Assessment Tool (EAT-10) questionnaire. Retrospective observational study of 21 patients treated with a transcervical anterior prevascular retrovisceral approach for symptomatic DISH with dysphagia as the primary symptom. All patients underwent videofluoroscopic study of swallowing before surgery and the EAT-10 questionnaire before and after the surgical procedure. A statistically significant (P < 0.001) improvement in the postoperative EAT-10 score was reported. Sixteen out of 21 patients (76.2%) had their symptoms completely resolved, with an EAT-10 score less than 3. These results were not influenced by age and sex nor by presence of tracheostomy. The preoperative EAT-10 score was consistently related to postoperative outcome. Patients with mild and moderate dysphagia had better Δ in EAT-10 scores than patients with severe and very severe dysphagia (P= 0.02). Surgical management seems to be effective in resolving swallowing disorders related to this disease in a consistent percentage of patients. This evidence is supported by the statistically significant improvement in EAT-10 scores after treatment. Moreover, it might be postulated that early intervention can guarantee a higher success rate because patients with severe and very severe dysphagia had significantly smaller improvement.

Cervical Alignment of Anterior Cervical Hyperostosis Causing Dysphagia.

Retrospective case control study. To investigate whether cervical alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis (DISH). DISH involves a wide range of ligamentous ossifications, which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown. We reviewed five patients with advanced dysphagia due to anterior cervical hyperostosis who underwent resection (S group), and five patients with mild symptoms who were only monitored (NS group). The patients were evaluated using the Eating Assessment Tool-10 (EAT-10) and plain kinetic radiographs of the cervical spine. The O-C2 angle, M-C angle, C2-7 angle, and C2-6a angle were measured in the flexion, neutral, and extension positions. We compared these parameters in the S group versus the NS group, and compared the pre- and postoperative values in the S group. The EAT-10 score indicated a high degree of dysphagia in the S group preoperatively (25 [22-27]) compared with the NS group (1 [1-6]). In the S group, the EAT-10 score significantly decreased postoperatively to 1 (0-1), and improvement of dysphagia was observed. There was a significant difference between the S and NS groups in the ΔC2-7 and ΔC2-6a, and between pre- and postoperative values in the S group. There were no significant changes in O-C2 angle and M-C angle, which are parameters of the superior cervical vertebrae. The present results suggest that the restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH. 4.

Surgical Treatment for Cervical Diffuse Idiopathic Skeletal Hyperostosis as a Cause of Dysphagia.

Introduction The majority of diffuse idiopathic skeletal hyperostosis (DISH) involving the anterior margin of the cervical vertebrae is asymptomatic, but it can cause dysphagia. Improvements in swallowing after surgical treatment have been reported in several case series. However, the appropriate amount of osteophyte resection for this disease in terms of the pathophysiology of dysphagia is still unknown. The current report describes the appropriate surgical procedure for dysphagia secondary to anterior cervical hyperostosis, and discusses the etiology of dysphagia. Methods This is a retrospective review of four patients who presented with complaints of dysphagia secondary to anterior cervical hyperostosis. All patients underwent videofluoroscopic esophagrams (VFEs) to identify the specific region associated with the dysphagia. Esophageal obstruction was present at C3-4 in two patients and at C4-5 in two patients. Three patients underwent localized and limited resection of the anterior cervical osteophytes. One patient underwent total resection of the anterior cervical osteophytes, because re-ossification had occurred after a previous resection. Results Postoperative VFE demonstrated an improvement in swallowing in the three patients who underwent limited resection of the osteophytes. The patient who underwent total resection of the osteophytes did not experience a full recovery of normal swallowing function. We concluded that the dysphagia was caused by both osteophyte obstruction and neuropathy resulting from the previous surgery or inflammation secondary to osteophyte irritation. Conclusions Localized and limited resection of anterior cervical osteophytes is recommended and should be considered for patients with dysphagia from anterior cervical hyperostosis.

Cervical Disc Arthroplasty Combined with Interbody Fusion for the Treatment of Cervical Myelopathy with Diffuse Idiopathic Skeletal Hyperostosis

Cervical Disc Arthroplasty Combined with Interbody Fusion for the Treatment of Cervical Myelopathy with Diffuse Idiopathic Skeletal Hyperostosis

Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) can cause ossification of ligaments and may affect the spine. We report a case of obstructive sleep apnea in a patient with significant upper airway narrowing secondary to cervical DISH. This patient had an initial apnea-hypopnea index (AHI) of 145 events/hour and was treated with uvulopalatopharyngoplasty, genial tubercle advancement, hyoid suspension, septoplasty, inferior turbinoplasties, and radiofrequency ablations to the tongue base which reduced his AHI to 40 events/hour. He redeveloped symptoms, was started on positive airway pressure (PAP) therapy, and later underwent a maxillomandibular advancement which improved his AHI to 16.3 events/hour. A few years later his AHI was 100.4 events/hour. His disease has gradually progressed over time and he was restarted on PAP therapy. Despite PAP titration, years of using PAP therapy, and being 100 percent compliant for the past three months (average daily use of 7.6 hours/night), he has an AHI of 5.1 events/hour and has persistent hypersomnia with an Epworth Sleep Scale questionnaire score of 18/24. At this time he is pending further hypersomnia work-up. DISH patients require prolonged follow-up to monitor the progression of disease, and they may require unconventional measures for adequate treatment of obstructive sleep apnea.

Diffuse Idiopathic Skeletal Hyperostosis Fracture: Case Report

Diffuse idiopathic skeletal hyperostosis is a frequently seen disease in emergency departments. Dysphagia due to serious cervical disease is reported in the literature. However, acute trauma-induced dysphagia as a result of cervical diffuse idiopathic skeletal hyperostosis fracture has not been reported in the literature. An eighty year-old male presented with neck pain and dysphagia after a fall; radiological assessments revealed C3-4, C4-5 hyperostosis decomposition secondary to trauma. Lornoxicam 16 mg/day, and methyl prednisolone 60mg/day was administered through the intravenous route. Oral intake was restricted for 24 hours, and the patient was observed for 24 hours. The patient was discharged with lornoksicam 8 mg/day, after the regression of complaints. Emergency physicians should diagnose hyperostosis fractures after trauma using lateral cervical x-rays in the elderly, as these fractures may lead to dysphagia. Dysphagia due to trauma of diffuse idiopathic skeletal hyperostosis may regress with anti-inflammatory treatment.

Cervical Myelopathy by C1 Posterior Tubercle Impingement in a Patient With DISH

A unique case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) associated with C1 posterior tubercle impingement resulting in spinal canal stenosis and cervical myelopathy. To describe an uncommon mechanism of spinal cord compression in patient with DISH. The neurologic deficits due to cervical DISH are relatively rare and a few cases of cervical spinal cord compression due to atlantoaxial subluxation, odontoid fracture, pseudotumor, ligamentous hypertrophy, and basilar impression have been reported. To the best of our knowledge, there has been no other report of a patient with DISH causing C1 posterior tubercle impingement and cervical myelopathy. A 75-year-old Japanese man, first diagnosed as hyperostosis of anterior and posterior longitudinal ligament 25 years ago, presented with gradual progression of numbness in both lower extremities, disturbed precise hand motion and urinary function. DISH, OPLL, and C1 posterior tubercle impingement was diagnosed by radiograph, CT, and MRI. Hyperintense signal in the C1 spinal cord on T2 weighted sequence was observed. Laminectomy from C1-C3 was performed. Myelocompression and myelopathy improved after the surgical intervention. Multilevel fusion of the subaxial cervical spine and increase of the mechanical stress on the craniocervical segment may leads to partial damage of the ligaments and resulted in C1 posterior arch impingement. This is the first report of unique C1 posterior tubercle impingement and myelopathy caused by DISH. We should keep it in mind that DISH can cause serious problems in the upper cervical spine even after 25 years of interval.

Long-term results of surgical treatment of dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis

Background context Large, prominent osteophytes along the anterior aspect of the cervical spine have been reported as a cause of dysphagia. Improvement of swallowing after surgical resection has been reported in a few case reports with short-term follow-up. The current report describes outcomes of a series of five patients with surgical treatment for this rare disorder, with a long-term follow-up. Purpose To study the clinical and radiographic outcomes of a case series of patients surgically treated for dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis (DISH). Study design Retrospective review of a case series. Patient sample Five cases from a University Hospital. Outcome measures Clinical and imagenological follow-up. Methods The records of five patients with dysphagia who had undergone anterior surgical resection of prominent osteophytes secondary to DISH were reviewed. Extrinsic esophageal compression secondary to anterior cervical osteophytes was radiographically confirmed via preoperative barium esophagogram swallowing study. All patients underwent anterior cervical osteophytes resection without fusion. Postoperatively, patients were followed-up clinically and radiographically with routine lateral cervical radiographs. Results Preoperative esophagogram showed that the esophageal obstruction was present at one level in three cases and two levels in two cases. The C3–C4 level was involved in three cases, C4–C5 in three cases, and C5–C6 in one case. There were no postoperative complications, including recurrent laryngeal nerve palsy, wound infection, or hematomas. All patients had resolution of dyphagia soon after surgery (within 2 weeks). Postoperative radiographs demonstrated complete removal of osteophytes. At final follow-up, ranging from 1 to 9 years (average 59.8 months, median 53 months), no patients reported recurrence of dysphagia. Final radiographic examination demonstrated minimal regrowth of the osteophytes. Conclusions Although rarely indicated, surgical resection of anterior cervical osteophytes from DISH causing dyphagia produces good clinical and radiographical outcomes. After thorough evaluation to rule out other intrinsic or extrinsic causes of swallowing difficulty, surgical treatment of this uncommon condition might be considered.

Diffuse idiopathic skeletal hyperostosis as an overlooked cause of dysphagia: a case report

IntroductionDysphagia is a common presentation in older people. Diffuse idiopathic skeletal hyperostosis affecting the cervical spine is an uncommon cause of dysphagia and may be overlooked.Case presentationWe present the case of an 88-year-old man with dysphagia and weight loss. Initial investigation with upper gastrointestinal endoscopy was inconclusive. A diagnosis of diffuse idiopathic skeletal hyperostosis as a cause for dysphagia was eventually made using video fluoroscopy. This showed a bony prominence impeding swallow at the level of C3. The patient was unfit for surgical management so a percutaneous endoscopic gastrostomy tube was inserted for feeding.ConclusionThe diagnosis of diffuse idiopathic skeletal hyperostosis involving the cervical spine often goes unrecognised as a cause of dysphagia despite its prevalence in the elderly population. Diagnosis is made using cervical radiographs, barium swallow and computed tomography. There is a risk of perforation with endoscopy in patients who have cervical diffuse idiopathic skeletal hyperostosis. Conservative management includes non-steroidal anti-inflammatory medications and a modified diet. Surgery may be considered in certain patients where conservative management fails.

Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine

Objectives: To describe the clinical manifestations and the complications of cervical spine (C-spine) involvement in diffuse idiopathic skeletal hyperostosis (DISH). Methods: Two patients, who presented with dysphagia resulting from large anterior osteophytes of the C-spine, were diagnosed as having DISH. A Medline search from 1964 to present, using the terms “diffuse idiopathic skeletal hyperostosis” and “cervical spine,” identified several clinical manifestations associated with DISH. Results: Two groups of conditions associated with DISH were found. 1. Spontaneous complications such as: dysphagia, being the commonest, dyspnea, stridor, myelopathy associated with ossification of the posterior longitudinal ligament (OPLL) or with atlanto-axial pseudoarthrosis or subluxation. Other rare events were aspiration pneumonia, sleep apnea and thoracic outlet syndrome. 2. Provoked complications such as endoscopic and intubation difficulties and fractures of the C-spine with frequent transverse shift of the fractured segment and resultant myelopathy. Conclusions: C-spine involvement in DISH is a recognized cause of various clinical manifestations involving the pharynx, larynx and the esophagus. Prior knowledge of the existence of cervical DISH should alert the clinicians for possible complications, at times severe, during invasive procedures in the neck region and as a consequence of trauma. Semin Arthritis Rheum 32:130-135. Copyright 2002, Elsevier Science (USA). All rights reserved.

Simultaneous cervical diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament resulting in dysphagia or myelopathy in two geriatric North Americans

BACKGROUND Cervical diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) rarely coexist in the North American population. Here, different surgical strategies were used to manage simultaneous DISH and OPLL resulting in dysphagia or myelopathy in two geriatric patients. METHODS A 74-year-old male with esophageal compression and dysphagia attributed to DISH, and cord compression with myelopathy due to OPLL, was treated with a cervical laminectomy followed by anterior DISH resection. On the other hand, an 80-year-old male with asymptomatic DISH but moderate myelopathy (Nurick Grade III) secondary to OPLL required only a cervical laminectomy. RESULTS In the first patient, dysphagia resolved within 3 months of surgery, while in the second individual, myelopathy improved to Nurick Grade I (mild myelopathy) within 6 months postoperatively. Improvement in both patients was maintained 1 year after surgery. CONCLUSIONS While DISH and OPLL may coexist in geriatric patients, only those with dysphagia should undergo DISH resection, while others demonstrating myelopathy should have laminectomy alone.