Morphological characteristics of diffuse idiopathic skeletal hyperostosis in the cervical spine

Abstract

ObjectivesDiffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior ossification of the spine and can lead to dysphagia and airway obstruction. The morphology of the newly formed bone in the cervical spine is different compared to the thoracic spine, possibly due to dissimilarities in local vascular anatomy. In this study the spatial relationship of the new bone with the arterial system, trachea and esophagus was analyzed and compared between subjects with and without DISH.MethodsCervical computed tomography (CT) scans were obtained from five patients with dysphagia and DISH and ten control subjects. The location of the vertebral and carotid arteries, surface area of the hyperostosis and distance between the vertebral body and the trachea and esophagus was assessed in the axial view.ResultsThe surface area of the newly formed bone was located symmetrically anterior to the vertebral body. The ossifications were non-flowing in the sagittal view and no segmental vessels were observed. Substantial displacement of the trachea/esophagus was present in the group with DISH compared to the controls.ConclusionsThe hyperostosis at the cervical level was symmetrically distributed anterior to the vertebral bodies without a flowing pattern, in contrast to the asymmetrical flowing pattern typically found in the thoracic spine. The hypothesis that the vascular system acts as a natural barrier against new bone formation in DISH could be further supported with these findings. The significant ventral displacement of the trachea and esophagus may explain the mechanism of dysphagia and airway obstruction in DISH.

Cervical spinal fracture in a patient with diffuse idiopathic skeletal hyperostosis having a history of cervical laminoplasty

“…In general, hyperostosis at the cervical level is symmetrically distributed anterior to the vertebral bodies without a flowing pattern. [ 4 ] The patient in our report had a history of laminoplasty before the hyperostosis. Hyperostosis and ankylosis occurred not only in the vertebral bodies but also in the previously operated laminae.…”

Multi-Level forestier syndrome in the cervical vertebra with an unusual radiographic appearance: Case report

“…Some patients may present with pain and restriction of range of motion [12] or suffer from dyspnea caused by tracheal obstruction, sleep apnea and stridor [13]. Also in rare cases, osteophytes compressing the jugular foramen, sympathetic chain, vertebral artery were reported [9].…”

Management of Airway Obstruction due to Diffuse Idiopathic Skeletal Hyperostosis in the Cervical Spine: A Case Report and Literature Review

“…DISH can occur in any part of the human skeleton; however, symptoms due to cervical ossification can be the most life-threatening. Through CT analyses of DISH and healthy subjects, Bakker et al found that hyperostosis at the cervical level was symmetrically distributed anterior to the vertebral bodies without a flowing pattern, in contrast to the asymmetrical flowing pattern typically found in the thoracic spine (12). The significant ventral displacement of the trachea and esophagus may be involved in the mechanism underlying the dysphagia and airway obstruction observed in DISH.…”