Diffuse idiopathic skeletal hyperostosis: A potential factor in the induction of thoracic spondylotic myelopathy

Thoracic spondylotic myelopathy presumably caused by diffuse idiopathic skeletal hyperostosis in a patient who underwent decompression and percutaneous pedicle screw fixation

“…DISH is associated with the diagnosis and therapeutic outcomes of various spinal diseases. In addition, DISH is a risk factor for the development of thoracic spondylotic myelopathy; 6 hence, there are sporadic reports of thoracic spondylotic myelopathy associated with DISH. 8 Because thoracic spondylotic myelopathy does not present with any upper limb symptoms, patients with coexisting lumbar spinal stenosis often have no enhanced tendon reflex of the lower limbs (PTR and ATR), and some patients have only symptoms caused by lumbar spinal stenosis alone, such as numbness and muscular weakness of the lower limbs.…”

“…In addition, it is reported that patients with diffuse idiopathic skeletal hyperostosis (DISH), in which ossification of the anterior longitudinal ligament causes osseous bridging of vertebral bodies resulting in ankylosis, 5 are likely to develop thoracic spondylotic myelopathy because of degeneration due to mechanical stress between the adjacent vertebral bone bridges. 6 …”

Can Diffuse Idiopathic Skeletal Hyperostosis Be Diagnosed by Plain Lumbar Spine X-Ray Findings Alone?

“…DISH, a condition previously not well recognized, has recently attracted attention and has been suggested to affect the surgical procedures for and treatment outcomes of various spinal diseases, including fractures and lumbar spinal canal stenosis. [6][7][8][9][10][11][12][13] Although lumbar spine X-ray is often performed in patients with low back pain or suspected lumbar spinal canal stenosis, thoracic spine X-ray and CT are performed less frequently due to lower incidence of thoracic spine diseases. The ability to infer the presence of DISH on plain X-ray images of the lumbar spine will allow for narrowing down of diseases to be screened and thereby reduce patients' exposure to radiation and medical costs.…”

“…3 Clinical symptoms associated with DISH include back pain, limited range of motion, 4 decreased vital capacity, aspiration, and airway obstruction. 5 Other features characterized by recent reports include increased vulnerability to vertebral fracture, 6 difficulty in achieving bone fusion during conservative treatment after vertebral fracture, 7 high possibility of requiring surgery, 8 a risk factor for thoracic myelopathy, 9 increased risk of pseudarthrosis after lumbar spinal fusion, 10 and a poor prognostic factor due to a high reoperation rate after lumbar decompression surgery. [11][12][13] Hence, DISH affects the diagnosis, treatment, and posttreatment outcome of spinal diseases.…”

“…DISH is a predisposing factor for thoracic myelopathy. 9 In patients with lower extremity symptoms who were diagnosed with lumbar spinal canal stenosis and underwent lumbar decompression alone, additional thoracic decompression may be required for overlooked thoracic myelopathy. 14 Evidence of ossification of at least 3 consecutive spinal levels is required for the diagnosis of DISH.…”