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Radiographic and Pathologic Features of Spinal Involvement in Diffuse Idiopathic Skeletal Hyperostosis *
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
Since their proposal in this study, the diagnostic criteria for DISH have remained consistent, with minor exceptions. The upper third ligamentous portion of the sacroiliac joint may demonstrate sclerosis and narrowing in patients with DISH.8 The lower synovial portion remains intact, unlike the ankylosis seen in AS. This differentiation may be made by CT evaluation.9 In 1978, Resnick et al. published a subsequent evaluation of cervical spine radiographs in patients with DISH demonstrating ossification of the posterior longitudinal ligament (PLL) in addition to the ALL. Among the 74 cervical radiographs evaluated, half demonstrated some degree of PLL ossification, with four demonstrating extensive calcification.10 This finding may result in spinal stenosis. Predilection for right-sided ALL ossification likely results from influence of the pulsating thoracic aorta, as the opposite pattern is seen in situs inversus.11 The etiology of DISH is still unknown, though there may be an association with insulin resistance and metabolic syndrome.12 Previously DISH was considered a radiographic finding with limited clinical significance. Recent evidence suggests spinal manifestations of DISH may result in pain and functional limitations as well as dysphagia.13 Those patients with severe manifestations of DISH may demonstrate spine immobility and postural deformity seen in advanced AS.14
Arthritis
Published in Harry Griffiths, Musculoskeletal Radiology, 2008
Ossification of the posterior longitudinal ligament (OPLL) appears mainly to involve the cervical spine in patients of Japanese origin (Fig. 72). Its etiology is unknown, but it can cause quite severe symptoms with cord compression. It is, however, seen occasionally in the caucasian population, possibly as a result of trauma.
Microscopic Posterior Foraminotomy/Laminotomy for Nerve Root Decompression
Published in Alexander R. Vaccaro, Christopher M. Bono, Minimally Invasive Spine Surgery, 2007
Troy D. Gust, Neal G. Haynes, Paul Arnold
For cases of myelopathy, central or paracentral stenosis secondary to a soft disc or osteophytic origin, deformity or instability, the laminoforaminotomy technique may not be the ideal procedure (8,15). Spondylosis or ossification of the posterior longitudinal ligament, associated with a kyphotic deformity, regardless of age, should be managed with direct anterior decompression and fusion, posterior laminoplasty (21–24), or both, rather than indirect posterior decompressive procedures. When myelopathy accompanies multifocal radiculopathy, hemilaminectomy, laminectomy, or laminoplasty may be warranted (12,17,25–32). However, in a series reported by Baba, excellent-to-good results were reported in 76% of patients undergoing en bloc open-door laminoplasty, and foraminotomy for selected patients with proven myelopathy and distinct unilateral radicular symptoms (33). The operative choice for lateral or foraminal pathology attributed to soft disc herniation, hypertrophied ligament or ossification of posterior longitudinal ligament (OPLL) degenerative spondylotic changes of the uncovertebral joints, osteophytes arising from the posterior articular facets or root sleeve fibrosis, includes both anterior or posterior approaches, including anterior discectomy with or without fusion or posterior laminoforaminotomy (11,13).
The Risk of overdiagnosis and overtreatment in spondyloarthritis
Published in Scandinavian Journal of Rheumatology, 2022
A Ortolan, M Lorenzin, A Doria, R Ramonda
This patient developed, in January 2021, pain and stiffness of the shoulder and hip girdle and increased inflammation indices (C-reactive protein 23 mg/L and erythrocyte sedimentation rate 79 mm/h). Since cervical stiffness was noted upon clinical examination, X-rays of the spine and pelvis were also performed. An ossification of the posterior longitudinal ligament (PLL) between C6 and C7 (Figure 1A) and a slight monolateral sclerosis of the sacroiliac joint (SIJ) (Figure 1D) were highlighted. Therefore, human leucocyte antigen (HLA)-B27 was assessed and it was found to be positive. Based on these findings, AS was the first diagnosis and the patient was treated with non-steroidal anti-inflammatory drugs, with only partial effect. Then, a 2 month course of medium-dose glucocorticoids was initiated (prednisone 25 mg daily, tapered to 7.5 mg in 4 weeks, then continued at a dose of 5 mg daily), with a brilliant response, including normalization of inflammatory indices. Thereafter, the patient was referred to our tertiary referral centre (Spondyloarthritis Clinic, Rheumatology Unit, Padova University) to initiate biological treatment.
Clinically suspected fibrocartilaginous embolism: a case report and literature review
Published in International Journal of Neuroscience, 2022
Wencan Ke, Chao Chen, Shuai Li, Bingjin Wang, Saideng Lu, Cao Yang
A 63-year-old woman was admitted to our hospital with a 4-year history of progressive numbness, pain, and weakness of bilateral lower extremities. On neurologic examination, she had normal strength in the upper extremities and decreased strength (score of 3–4 out of 5) in the lower extremities. The inguinal and perineal regions had a sense of constriction. No significant abnormal results were found on laboratory tests and her medical history was unremarkable. Magnetic resonance imaging (MRI) of the thoracic spine showed significant spinal cord compression extending from T2 to 3 on sagittal T2-weighted images (Figure 1A). Computerized tomography (CT) indicated severe spinal canal stenosis with ossification of the posterior longitudinal ligament at the T2 to 3 level (Figure 1B). To relieve the thoracic spinal stenosis, the patient underwent laminectomy and fusion with pedicle screw fixation using a posterior approach under monitoring of somatosensory evoked potential (SEP) and motor evoked potential (MEP). A drainage tube was placed in the wound because of the leakage of cerebrospinal fluid (CSF).
The relationship of diffuse idiopathic skeletal hyperostosis, visceral fat accumulation, and other age-related diseases with the prevalent vertebral fractures in elderly men with castration-naïve prostate cancer
Published in The Aging Male, 2020
Daisuke Watanabe, Hiromitsu Takano, Takahiro Kimura, Akemi Yamashita, Tadaaki Minowa, Akio Mizushima
Diffuse idiopathic skeletal hyperostosis (DISH) is a disease in which the longitudinal ligaments and tendon attachments of the spinal cord gradually become ossified, causing ankylosing disorders of the spine [9]. Although ossification of the anterior longitudinal ligament is the main characteristic, it is sometimes accompanied by ossification of the posterior longitudinal ligament, the yellow ligament, and the extraspinal ligament. When multiple vertebral bodies are connected by ossification, the spine loses motility, causing falls due to imbalance and immobilization-associated osteoporosis [10]. The risk of vertebral fracture in patients with DISH is known to be higher than that in patients without DISH [10]. Although the cause of DISH is unknown, it is more common in males than in females, and it has been reported that aging, obesity, and type 2 diabetes are associated with the increase of its prevalence [11–15]. It is reported that the prevalence of DISH in males is 13–22.7% [12,15,16], while that in male patients over 70 years of age is 38–44% [17]. Most patients with prostate cancer are elderly males. Moreover, visceral fat obesity is attracting attention as a risk factor because of the relationship between the progress of prostate cancer and visceral fat accumulation [18,19]. With these partially common epidemiological characteristics of prostate cancer and DISH, patients with prostate cancer are expected to have a high prevalence of DISH.