Thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis: a case report

Abstract

BackgroundDiffuse idiopathic skeletal hyperostosis has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Neurological complications are rare in diffuse idiopathic skeletal hyperostosis. However, if they do occur, the consequences are often significant enough to warrant major neurosurgical intervention. Neurological complications occur when the pathological process of ossification in diffuse idiopathic skeletal hyperostosis extends to other vertebral ligaments, causing ossification of the posterior longitudinal ligaments and/or ossification of the ligamentum flavum. Thoracic spondylolisthesis with spinal cord compression in diffuse idiopathic skeletal hyperostosis has not previously been reported in the literature.Case presentationA 78-year-old Japanese man presented with a 6-month history of gait disturbance. A magnetic resonance imaging scan of his cervical and thoracic spine revealed anterior spondylolisthesis and severe cord compression at T3 to T4 and T10 to T11, as well as high signal intensity in a T2-weighted image at T10/11. Computed tomography revealed diffuse idiopathic skeletal hyperostosis at T4 to T10. He underwent partial laminectomy of T10 and posterior fusion of T9 to T12. The postoperative magnetic resonance imaging revealed resolution of the spinal cord compression and an improvement in the high signal intensity on the T2-weighted image.ConclusionsWe report the first case of thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis. Neurosurgical intervention resulted in a significant improvement of our patient’s neurological symptoms.

Improved Pain and Quality of Life with Corrected Thoracic and Lumbosacral Spondylolisthesis Subluxations Using CBP®: A Case Study and 1-Year Follow-Up

“…However, from the available literature, "All reported cases of thoracic spondylolisthesis have occurred in people of Asian ethnicity [and] most of them were concomitant with lumbar spondylosis or diffuse idiopathic skeletal hyperostosis (DISH) [33]." In published cases with TS, the spinal imaging shows loss in or reversal of sagittal thoracic curvature at and surrounding the TS [33][34][35][36][37].…”

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

“…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. 9 Thus, caution should be exercised not to overlook thoracic spondylotic myelopathy.…”

Thoracic degenerative spondylolisthesis-associated myelopathy

“…He suggested that the facet joint laxity and disc degeneration were believed to be responsible for the development of thoracic spondylithesis. Takagi et al reported a case of thoracic spondylolisthesis and spinal cord compression in DISH [3] . He believed that DISH resulted in the fusion of several spinal segments, and the unfused segments were more vulnerable to segmental instability and development of spondylolisthesis.…”

“…However, most of them were concomitant with lumbar spondylosis or diffuse idiopathic skeletal hyperostosis (DISH). [2,3] Here we report a case of thoracic degenerative spondylolisthesis-associated myelopathy in which the lower thoracic region was the only region involved and to discuss the mechanism of thoracic spine spondylolisthesis.…”