Diffuse idiopathic skeletal hyperostosis (DISH) is a non‐inflammatory spondyloarthropathy identified radiographically by calcification of the ligaments and/or entheses along the anterolateral aspect of the vertebral column. The etiology and pathogenesis of calcifications are unknown, and the diagnosis of DISH is currently based on radiographic criteria associated with advanced disease. To characterize the features of calcifications associated with DISH, we used micro‐computed tomographic imaging to evaluate a cohort of 19 human cadaveric vertebral columns. Fifty‐three percent of the cohort (n = 10; 3 females, 7 males, mean age of death = 81 years, range 67–94) met the radiographic criteria for DISH, with calcification of four or more contiguous vertebral segments. In almost all cases, the lower thoracic regions (T8‐12) were affected by calcifications, consisting primarily of large, horizontal outgrowths of bony material. In contrast, calcifications localized to the upper thoracic regions demonstrated variability in their presentation and were categorized as either “continuous vertical bands” or “discontinuous‐patchy” lesions. In addition to the variable morphology of the calcifications, our analysis demonstrated remarkable heterogeneity in the densities of calcifications, ranging from internal components below the density of cortical bone to regions of hyper‐dense material that exceeded cortical bone. These findings establish that the current radiographic criteria for DISH capture heterogeneous presentations of ectopic spine calcification that can be differentiated based on morphology and density. These findings may indicate a naturally heterogenous disease, potential stage(s) in the natural progression of DISH, or distinct pathologies of ectopic calcifications. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
Sequestered disc fragments do not have indistinctive features and often share the clinical and radiological presentation as spinal neoplasms making their diagnosis and treatment a clinical challenge.We report a rare case of sequestered lumbar disc fragment at the level of L2-L3 in a 70-year-old male who presented to the ER complaining of six years' history of low back pain with acute onset lower extremities weakness for six days, associated with right foot drop. He was admitted for tumor workup as the MRI showed diffuse bone high signal intensity throughout the spine with a soft tissue epidural mass at L2/3, causing severe compression on the cauda equina nerve roots. The patient underwent L2-L3 decompression and fixation, mass excision, multiple open biopsies. Soft tissue biopsy of the mass revealed fibrocartilaginous tissue consistent with the intervertebral disc, while the bone biopsy was diagnostic of acute leukemia. The patient was observed postoperatively with unremarkable complications. He did well with physiotherapy, and there was a remarkable improvement of his right lower extremity power reaching 4/5.Our case presented a rare phenomenon in which sequestered disc fragments manifested clinically and radiologically as a spinal neoplasm. Vigilant history taking and physical examination are paramount; a physician should be watchful for any red flags that may warrant further investigation such as in our case.
Introduction:Spine Surgery is considered a moderate risk for developing Venous Thromboembolism (VTE). To our knowledge, no study has been done to determine the incidence of VTE in our local population. We aim to study this and determine the factors associated with developing VTE post spine surgery. Material and Methods:A retrospective chart review was conducted to analyze 892 adult patients who underwent either an elective or emergency spine surgery. Demographics, length of surgery and hospital stay, diagnosis, and location of surgery in addition to the type of trauma, if applicable, were collected. Furthermore, spiral computed tomography was used to diagnose pulmonary embolism (PE), and duplex ultrasound was used to diagnose deep vein thrombosis (DVT) pre- and post-operatively. Results:800 patients were included. The overall incidence of VTE was 4.1%. In addition, Lumbar spine was the most common location operated on. Increasing age and length of hospital stay were both significantly associated with development of VTE. Furthermore, cervical spine surgery had a lower incidence of VTE compared to other locations which was statistically significant. Lastly, non-ambulatory patients had a higher risk of having VTE compared to patient who were able to ambulate post-operatively. Conclusion:The incidence of VTE after spine surgery is considered low but carries high rates of morbidity and mortality. Increased age and prolonged hospital stay increases its risk while early ambulation lowers it. Larger prospective study is needed to identify the best prophylactic anticoagulation regimen. Prophylactic measures against VTE are highly recommended, especially amongst high-risk patients. IRB approval:This study has been submitted and approved by the Institutional Review Board (IRB).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.