Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects

Abstract

BackgroundComputed tomography (CT) analyses have reported that the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in Japan is 8.7–27.1%. However, these data were obtained using chest-abdominal CT, and no evaluations of sagittal, coronal, and axial images using whole-spine CT have been reported. The aim of this study was to investigate the prevalence and characteristic of DISH by whole spinal CT.MethodsParticipants were patients who had experienced trauma who had undergone whole-spine CT scanning based on the initial clinical practice guidelines for trauma in our institute from April 2015 to February 2018. The subjects were > 20 years old and 1479 were included in the analysis. The presence and distribution of DISH and clinical parameters such as age and sex were reviewed retrospectively according to the location of DISH.ResultsThe overall prevalence of DISH was 19.5% (n = 289). Subjects with DISH were older than those without. DISH was located in the thoracic spine in 65.1% and thoracolumbar spine in 24.2% of patients. More than 80% of ligamentous ossifications associated with DISH occurred at T8 (n = 255, 88%), T9 (n = 262, 91%), and T10 (n = 247, 85%). Most of the ossification occurred to the right anterior of the vertebral body, and there were few ossifications in the areas in contact with the artery and vein.ConclusionsThe prevalence of DISH based on whole-spine CT was 19.5%. Ossification was noted more often at T8, T9, and T10, and to the right anterior of the vertebral body. It is for the first time report that we have studied the location of ossification in detail using the axial images of whole spine CT. We hope this study will enhance the understanding of the characteristics of DISH.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2108-5) contains supplementary material, which is available to authorized users.

A Comparison of Cervical and Thoracolumbar Fractures Associated with Diffuse Idiopathic Skeletal Hyperostosis—A Nationwide Multicenter Study

“…In this study, fractures in the DISH-ankylosed spine were heavily oriented toward thoracolumbar cases, which is different from the literature that reports more cervical than thoracolumbar fractures in cases with DISH: the percentages of cervical and thoracolumbar fractures were reported as 62.8% and 37.2 by Westerveld in 2009 [10], 52.5% and 47.5% by Westerveld in 2014 [12], 61.5% and 57.7% by Teunissen [13], and 50% each by Caron [9]. While the effect of race in DISH-affected levels cannot be excluded, the greater number of fractures in the thoracolumbar region seems natural because the highest prevalence of DISH has been reported to be at the T8-T10 levels in Japanese patients [14,15]. High prevalence of cervical OPLL may have also affected data collection, because some DISH+OPLL cases may have been catalogued only as cervical spine fracture with OPLL and missed by the retrospective screening for DISH-associated fractures.…”

“…Fujimori evaluated 1500 Japanese patients who underwent positron emission tomography and CT and reported a 12% prevalence of DISH [21]. Hiyama evaluated the prevalence of DISH in 1479 trauma patients who were screened for injury using head-to-pelvis CT scans and reported a 19.5% prevalence [14]. While the true incidence of DISH among the Japanese population remains unknown, spine surgeons in Japan are increasingly encountering spinal fractures in patients with DISH.…”

Response to: ‘Frequency of MRI changes suggestive of axial spondyloarthritis in the axial in a large population-based cohort of individuals aged <45 years' by Parperis

“…Further, no follow-up data of the individuals are available yet. However, the likelihood of a high prevalence of DISH in a population with a mean age of 38 years is below 1% 5. Considering the dramatic increase of DISH in older age groups, only a small subset of participants in our study might have represented early cases of DISH.…”

Can Diffuse Idiopathic Skeletal Hyperostosis Be Diagnosed by Plain Lumbar Spine X-Ray Findings Alone?

“…9 In patients with lower extremity symptoms who were diagnosed with lumbar spinal canal stenosis and underwent lumbar decompression alone, additional thoracic decompression may be required for overlooked thoracic myelopathy. 14 Evidence of ossification of at least 3 consecutive spinal levels is required for the diagnosis of DISH. 3 Because of a high incidence of DISH bridging in the thoracic spine 14 and a high rate of being overlooked on plain thoracic spine X-ray, 15 spinal computed tomography (CT) is recommended for diagnosing DISH.…”

“…14 Evidence of ossification of at least 3 consecutive spinal levels is required for the diagnosis of DISH. 3 Because of a high incidence of DISH bridging in the thoracic spine 14 and a high rate of being overlooked on plain thoracic spine X-ray, 15 spinal computed tomography (CT) is recommended for diagnosing DISH. However, performing CT and additional X-ray of the thoracic spine to determine the presence or absence of DISH in patients with lumbar spinal complaints is not desirable because it increases stress, radiation exposure, and medical economic burden to patients.…”