Progression of Ossification of the Anterior Longitudinal Ligament Associated With Diffuse Idiopathic Skeletal Hyperostosis by Age: A Study of Computed Tomography Findings Over 5 Years

Abstract

Study Design: Observational study. Objective: To investigate whether the progression of anterior longitudinal ligament ossification varies by age among patients with diffuse idiopathic skeletal hyperostosis (DISH). Methods: Of the patients who underwent computed tomography (CT) of the thoracic to pelvic region at least twice from 2009 to 2018, 191 who underwent CT at an interval of 5 years and 0 months to 5 years and 2 months were enrolled (87 men and 104 women). Sex, age at the time of the first CT scan, the presence/absence of DISH, level of complete vertebral body fusion associated with DISH, and extent of ligament ossification using the modified Mata scoring system were investigated. Results: DISHs were detected in 53 (27.7%) of 191 patients. The score of ligament ossification increased over time in 35 (66%) of 53 patients; 93 intervertebral spaces were affected. The percentage of completely fused intervertebral spaces increased by 6.7% from 31.3% to 38.0% over time. The increase in score for all intervertebral spaces in individual patients was significantly greater in the ≤70 years old group (2.7 ± 2.8 points, n = 28) than in the ≥71 years old group (1.2 ± 1.4 points; n = 25; P = .028). The mean age of patients with a recorded score that increased by ≥1 point was 67.4 years and that of patients without any change in the score was 73.3 years ( P = .036). Thus, patients with recorded changes in the score were younger. Conclusion: During the approximately 5-year period, ossification progressed more in younger patients than in older patients.

Spatiotemporal changes in imaging features associated with diffuse idiopathic skeletal hyperostosis (DISH)

“…Our findings of increased prevalence of complete bridges (from 67.7% to 74.1% of motion segments) in individuals with DISH in both images are in keeping with previous studies reporting increases in complete bridging in individuals with DISH over the course of 5 years from 45% to 56%, 20 54% to 59% 19 and 31% to 38%. 25 These results reinforce the progressive nature of DISH following clinical diagnosis. 20 25 Our analysis further showcased the extent of ectopic bridging by highlighting the involvement of early forms of bridging in non-contiguous regions of the thoracic spine with DISH.…”

Imaging Features of Early Diffuse Idiopathic Skeletal Hyperostosis (pre-DISH): Analysis of Progression of Ligament Ossification over 5 Years by Computed Tomography

“…Progression occurs gradually, although ligament ossification in DISH is progressive 5,7,8) . Murakami et al 5) examined the progression of ligament ossification by age group, reporting that Spine Surgery and Related Research J-STAGE Advance Publication (April 21, 2023) Ⓒ The Japanese Society for Spine Surgery and Related Research. CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/).…”

“…Moreover, DISH is detected in more than 50% of men in their 80s 4) . Ossification also more rapidly progresses in younger people 5) . Based on these findings, ligament ossification in DISH appears to be a pathological condition that gradually progresses.…”

Intraoperative Traction May Induce Acute Onset Dysphagia With Diffuse Idiopathic Skeletal Hyperostosis After Anterior Cervical Discectomy

“… 12) Among patients with DISH, ossification progressed more in younger patients during the 5-year follow-up periods. 10) The causes of anterior cervical osteophyte-induced dysphagia include direct compression of the pharynx or esophagus and inflammatory changes in the prevertebral fascia, resulting in fibrosis and adhesion to the esophagus. Therefore, DISH may be a cause of dysphagia and airway obstruction.…”

“… 9) The risk of traumatic fracture in DISH depends on the severity of ossification. 10) Dysphagia initially presents with difficulty in swallowing solid food, slowly progressing to soft food and liquids. Some authors 3) have indicated that prevertebral soft tissue thickness (PVST) is more important than the thickness of osteophytes for the occurrence of dysphagia.…”