Diffuse Idiopathic Skeletal Hyperostosis Prevalence, Characteristics, and Associated Comorbidities: A Cross-Sectional Study of 1815 Whole Spine CT Scans

Abstract

Study Design A Retrospective Study Objective To determine the prevalence and characteristics of DISH using whole spine CT scans and to evaluate the association of DISH with co-morbidities and other ossified lesions. Method A retrospective study of whole-spine CT scans of polytrauma patients from 2018-2021 above the age of 20 years. The screening was done using modified Resnick criteria. Overall and age-specific prevalence, characteristics, and associations with obesity, diabetes mellitus (DM), ischemic heart disease (IHD), aortic calcification (AC), ossified posterior longitudinal ligament (OPLL), and ossified ligamentum flavum (OLF) were evaluated. Results Out of 1815 patients, 347 had DISH, with a prevalence rate of 19.1% and a mean age of 61.7 years. The highest prevalence of DISH was seen in individuals over 80 years of age (45.5%). The prevalence among males (20.2%) was higher than for females (14.9%). The most commonly involved level was T8-T9 (95.4%), followed by T9-T10 (91.9%), and the most common vertebra involved was T9 (96%). All the cases involving T9 had ossification on the right anterior aspect of the vertebral body. The presence of DM, high BMI, and IHD was found to be significantly higher in patients with DISH (P value < .001). The incidence of aortic calcification was 22.5%, OPLL was 13.3%, and OLF was 4.9% in patients with DISH. Conclusion This study reports a prevalence rate of 19.1% for DISH, with the highest prevalence among individuals above 80 years of age (45.5%). DISH has a higher propensity to affect the right anterior aspect of the vertebral body in the thoracic spine and is strongly associated with obesity, DM, IHD, and AC.

Examining the Association Between the Extent of Anterior Longitudinal Ligament Ossification Progression and Comorbidities in Diffuse Idiopathic Skeletal Hyperostosis

“…The correlation of advanced age with male sex has been reported in many articles [ 4 , 5 , 12 , 16 - 20 ]. In the current study, the DISH group included significantly older patients and more men than the non-DISH group, as suggested.…”

“…In the current study, the DISH group included significantly older patients and more men than the non-DISH group, as suggested. Although the causes of DISH are unknown, it is considered that chronic inflammation may be involved in the stage before the condition onset [ 21 ] and also that mechanical stress is involved as the apical vertebra of thoracic kyphosis is frequently ossified [ 4 ]. If ossification occurs along with the upsurge of inflammation and stress with age, a higher prevalence in elderly individuals would be expected.…”

“…The progression of anterior longitudinal ligament ossification varies in extent among patients with DISH. Some patients display bridging of only four adjacent vertebral bodies (the minimum number required to meet the diagnostic criteria), whereas others exhibit bridging of almost all 24 vertebral bodies from the cervical to sacral spine [ 4 ]. Additionally, the bridging of vertebral bodies progresses more rapidly in younger patients [ 5 ], and the number of fused vertebral bodies increases over the duration of the condition [ 6 ].…”

Not All Osteophytes Are Located on the Right Side of the Vertebrae in Diffuse Idiopathic Skeletal Hyperostosis: A Quantitative Analysis in Relation to the Position of Aorta

“…Previous studies have focused on thoracic vertebra osteophytes occurring on the right side of the spine and opposite to the aorta, 21,22 and then speculated that pulsating aorta inhibited osteophytes. Yet, our study showed that osteophytes in DISH were not always located on the right side at all vertebral segments.…”

Diffuse idiopathic skeletal hyperostosis, beyond the musculoskeletal system

“…Serum IGF-1, insulin, and growth hormone (GH) levels are significantly higher in patients with DISH than in normal controls [37,38]. Notably, basal serum insulin levels were significantly elevated in DISH patients with a BMI > 28 kg/m 2 , with a strong positive correlation between BMI values and serum insulin concentrations but not with basal serum GH or IGF-1 levels [39]. Corticosteroids and/or non-steroidal anti-inflammatory drug-related improvement of DISH symptoms (reduction in muscle pain and joint stiffness, increase in spinal range of motion) resulted in lower serum GH levels, but IGF-1 levels were unchanged, suggesting that elevated GH, and not IGF-1, contributed to the progression of clinical symptoms in DISH [37].…”