Diffuse Idiopathic Skeletal Hyperostosis Causing Acute Thoracic Myelopathy: A Case Report and Discussion

Reisner, Andrew; Stiles, R G; Tindall, Suzie C.

doi:10.1227/00006123-199003000-00020

Cited by 22 publications

(16 citation statements)

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“…In another study evaluating thoracic cord compression due to OLF, only 1 of the 15 patients was diagnosed with DISH (12). We noticed two case reports in which OLF associated with DISH causing myelopathy was described in the literature (7,8). In the present case, disc herniation together with bridging new bone formation on the anterior side and OLF on the posterior side of the spinal canal caused severe narrowing in a patient with DISH, and OPLL was not a part of this process.…”

Section: S82mentioning

confidence: 47%

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Thoracic Myelopathy Due to a Combination of Disc Herniation, Ossified Ligamentum Flavum, and Bridging New Bone Formation in a Patient with Diffuse Idiopathic Skeletal Hyperostosis: Triple Crush!

Ulaşlı¹,

Erdal²,

Duymuş³

et al. 2014

Turk J Phys Med Rehab

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ÖzetTorasik miyelopati nadir görülen bir durumdur ve difüz idiyopatik skeletal hiperostoz (DİSH), ossifiye posterior longitudinal ligament, ossifiye ligamentum flavum (OLF) ve disk herniasyonlarına bağlı olabilir. Biz bu olguda her iki bacağında güçsüzlük, hissizlik ve yürüme güçlüğü ile baş-vuran DİSH'li bir hastayı tartıştık. Disk herniasyonu, köprüleşen yeni kemik oluşumları ve OLF ileri spinal kanal darlığına katkıda bulunmuşlardı. DİSH yaşlı insanların hastalığı olsa da, hasta nispeten gençti ve diyabet ile obezite hikayesi yoktu. Dahası hasta minör bir travma öncesine kadar asemptomatik idi. Bu olgu, klinisyenlerin hızlı tanı konulup erken cerrahi uygulandığında daha iyi bir prognozla sonuçlanan bu nadir durumun farkında olması amacıyla sunulmuştur. Anahtar Kelimeler: Difüz idiyopatik skeletal hiperostoz, torasik miyelopati, ligamentum flavum AbstractThoracic myelopathy is an uncommon condition and may be due to diffuse idiopathic skeletal hyperostosis (DISH), ossified posterior longitudinal ligament (OPLL), ossified ligamentum flavum (OLF), and disc herniation. In the present case, we discussed a patient with DISH who presented with weakness and numbness in both legs and gait difficulty after a sudden trauma. Disc herniation, bridging new bone formation, and OLF were found to contribute to severe spinal canal narrowing. Although DISH is a disease of elderly patients, the patient was relatively young with no history of diabetes and obesity. Furthermore, the patient was asymptomatic until a minor trauma. This case was reported for clinicians to be aware of this rare condition, in which prompt diagnosis and early surgical management may result in better prognosis.

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Section: S82mentioning

confidence: 47%

“…Qunfeng et al (4) reported neurological deficits due to OPLL and OLF causing spinal cord compression associated with DISH. Reisner and Wilson also reported that OLF associated with DISH had an important role in the development of neurologic deficits, mainly in the thoracic spine (7,8).…”

Section: Discussionmentioning

confidence: 95%

Thoracic Myelopathy Due to a Combination of Disc Herniation, Ossified Ligamentum Flavum, and Bridging New Bone Formation in a Patient with Diffuse Idiopathic Skeletal Hyperostosis: Triple Crush!

Ulaşlı¹,

Erdal²,

Duymuş³

et al. 2014

Turk J Phys Med Rehab

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“…Additional anterior decompression may be required, which is technically demanding due to OALL. In the previous studies, OLF associated with DISH played an important role in the development of neurological deficits in the thoracic or lumbar spine [18][19][20]. Because OLF often occurred at the still-mobile levels, above and/or below which the spine was ankylosed [18][19][20], we postulated that the pathomechanism might be similar to that in occipitoatlantoaxial lesions.…”

Section: Discussionmentioning

confidence: 82%

“…Chronic and continuous stress at the nonunion level contributed to hypertrophy or OLF. In these cases, posterior decompression and stabilization could achieve excellent outcomes [18][19][20].…”

Section: Discussionmentioning

confidence: 95%

“…a OALL at C2-C7, b OPLL (black arrow) and OLF (white arrow) at T1-2, c no sacroiliac erosion characterized by ligamentous ossification of the anterolateral side of the spine, sparing the disc and joint space [1][2][3][4]. Although typically asymptomatic, DISH has been associated with neurological problems [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (Table 2), of which the reported rate is 4% [21]. DISH alone can cause spinal cord compression, mostly in the upper cervical spine.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review

Guo

Yang

et al. 2010

Eur Spine J

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A rare case of a 44-year-old Chinese male with diffuse idiopathic skeletal hyperostosis (DISH) and simultaneous ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) at T1-2 causing thoracic myelopathy is reported herein. Posterior decompression without extirpating the OPLL was performed at T1-2. Postoperatively, symptoms were greatly improved, with remaining hyperreflexia and Grade 4/5 muscle strength in the lower extremities. The Japanese Orthopedic Association score improved from 5 preoperatively to 9 at final follow-up. The presence of a cyst due to leakage of cerebrospinal fluid was confirmed by MRI at day 27, but it resolved after conservative management. The clinical manifestation of DISH, the relationship among DISH, OPLL, and OLF, and management of thoracic myelopathy due to OPLL and OLF were reviewed.Keywords Diffuse idiopathic skeletal hyperostosis Á Ossification of the posterior longitudinal ligament Á Ossification of the ligamentum flavum Á Upper thoracic Á Myelopathy

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Vertebral pseudoarthrosis associated with diffuse idiopathic skeletal hyperostosis

1994

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Diffuse idiopathic skeletal hyperostosis is an ossifying diathesis that commonly affects the vertebral skeleton. Spinal ankylosis can occur, predisposing the spine to abnormal stresses and fracture. Fracture through an ankylosed segment with continued motion at the site of fracture can result in pseudoarthrosis. Pseudoarthrosis can also develop at the junction of the fused and mobile spine secondary to chronic abnormal stresses. This complication is manifest radiographically by single-level intervertebral disc space destruction, vertebral endplate erosions, marked vertebral sclerosis, and large osteophytes. The radiographic manifestations can mimic infective spondylitis or neuropathic changes.

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Diffuse Idiopathic Skeletal Hyperostosis Causing Acute Thoracic Myelopathy: A Case Report and Discussion

Cited by 22 publications

References 0 publications

Thoracic Myelopathy Due to a Combination of Disc Herniation, Ossified Ligamentum Flavum, and Bridging New Bone Formation in a Patient with Diffuse Idiopathic Skeletal Hyperostosis: Triple Crush!

Thoracic Myelopathy Due to a Combination of Disc Herniation, Ossified Ligamentum Flavum, and Bridging New Bone Formation in a Patient with Diffuse Idiopathic Skeletal Hyperostosis: Triple Crush!

Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review

Vertebral pseudoarthrosis associated with diffuse idiopathic skeletal hyperostosis

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