Radiographic, clinical, and histopathologic evaluation with surgical treatment of Forestier's disease

Barsamian, James G.; Cobb, Larry W.; Bremer, Alfonso M.; Scheffer, Robert B.; Northup, H M

doi:10.1016/0030-4220(85)90004-0

Cited by 16 publications

(5 citation statements)

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“…There are mixed reports regarding the involvement of the anterior longitudinal ligament in the pathogenesis of DISH. Some studies have reported mineralization of the anterior longitudinal ligament in DISH, 21,24,40 whereas others report that the anterior longitudinal ligament does not undergo mineralization 1,21 or that it is displaced by the formation of ectopic mineral structures. 26 In the current study, when present in the histological sections examined, the structure of the anterior longitudinal ligament was typically preserved.…”

Section: Discussionmentioning

confidence: 99%

“…2 The histopathological characteristics of DISH are less well known. Initial reports described histopathological features of endochondral ossification of the anterior longitudinal ligament 24 as well as changes in the gross features of the IVD. 21,25 In contrast, recent studies in cadaveric tissues demonstrated that the anterior longitudinal ligament was morphologically normal in appearance and was displaced by ectopic mineral, but did not itself undergo aberrant mineralization.…”

Section: Introductionmentioning

confidence: 99%

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Dystrophic calcification and heterotopic ossification in fibrocartilaginous tissues of the spine in diffuse idiopathic skeletal hyperostosis (DISH)

et al. 2020

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Diffuse idiopathic skeletal hyperostosis (DISH) is a prevalent noninflammatory spondyloarthropathy characterized by ectopic mineral formation along the anterolateral aspect of the vertebral column, yet little is known about its underlying pathogenesis. Our objective was to evaluate the histopathological features and composition of ectopic mineral within spinal tissues affected by DISH in humans. Thoracic spine segments from six embalmed cadaveric donors (one female and five males; median age 82 years) meeting the radiographic diagnostic criteria for DISH were evaluated using radiological, histological, and physical analyses. Overall, the histological features of ectopic mineralization at individual motion segments were heterogeneous, including regions of heterotopic ossification and dystrophic calcification. Heterotopic ossifications were characterized by woven and lamellar bone, multifocal areas of metaplastic cartilage, and bony bridges along the anterior aspect of the intervertebral disc space. Dystrophic calcifications were characterized by an amorphous appearance, a high content of calcium and phosphorus, an X-ray diffraction pattern matching that of hydroxyapatite, and radiodensities exceeding that of cortical bone. Dystrophic calcifications were found within the anterior longitudinal ligament and annulus fibrosus in motion segments both meeting and not meeting the radiographic criteria for DISH. In summary, our findings indicate that in DISH, ectopic mineral forms along the anterior aspect of the spine by both heterotopic ossification and dystrophic calcification of fibrocartilaginous tissues. Although both types of ectopic mineralization are captured by current radiographic criteria for DISH, dystrophic calcification may reflect a distinct disease process or an early stage in the pathogenesis of DISH.Bone Research (2020) 8:16; https://doi.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dystrophic calcification and heterotopic ossification in fibrocartilaginous tissues of the spine in diffuse idiopathic skeletal hyperostosis (DISH)

et al. 2020

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“…Although our study showed the new bone formation to have continuity with the adjoining vertebral bodies it can not be concluded that independent ossification of the anterior longitudinal ligament could not occur. In 1985, Barsamian et al presented a case report of a 63‐year‐old woman with dysphagia due to cervical DISH . The DISH bone formation was removed surgically and the histological evaluation showed a thin cortex with islands of metaplastic hyaline cartilage and absence of the anterior longitudinal ligament.…”

Section: Discussionmentioning

confidence: 99%

“…In 1985, Barsamian et al presented a case report of a 63-year-old woman with dysphagia due to cervical DISH. 19 The DISH bone formation was removed surgically and the histological evaluation showed a thin cortex with islands of metaplastic hyaline cartilage and absence of the anterior longitudinal ligament. Another section showed thickening of the cortical bone and the authors concluded that the abnormalities corresponded to both ossification of the anterior longitudinal ligament and to the type II lesions of Resnick.…”

Section: Histological Characteristics Of Dishmentioning

confidence: 99%

Histological characteristics of diffuse idiopathic skeletal hyperostosis

Kuperus

Westerveld

Rutges

et al. 2016

Journal Orthopaedic Research

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Diffuse idiopathic skeletal hyperostosis (DISH) is a predominantly radiographic diagnosis and histological knowledge of DISH is limited. The aim of this study was to describe the histological characteristics of DISH in the spinal column and to study the relation between DISH and intervertebral disc (IVD) degeneration. Therefore, 10 human cadaveric spines with fluoroscopic evidence of DISH were compared with 10 controls. Plain radiographs and computed tomography (CT) scans were obtained and tissue blocks were resected from three predefined levels of all specimens. The microscopic sections were scored by two blinded observers using a newly developed scoring system specific for characteristics of DISH and a validated scoring system for IVD degeneration. Maximum IVD height was measured on the CT scans. Analyses were performed using Fisher's exact test and Student's t-test. When compared to controls, the right sided sections from DISH specimens showed partial or complete bone bridges, consisting of cortical woven bone, accompanied by morphological changes in the adjoining part of the IVD. Using the histological scoring system for DISH, all parameters were significantly different between the DISH and control group (p < 0.01). The contralateral location did not show differences between the groups. The overall degree of IVD degeneration and height of IVD was comparable for the two groups. The histopathological changes observed in spines with DISH corresponded to the fluoroscopic images and CT scans. The degree of IVD degeneration and IVD height was comparable for both groups, suggesting a limited role for IVD degeneration in the pathogenesis of DISH. Keywords: diffuse idiopathic skeletal hyperostosis (DISH); histology; classification; ossification; disc degeneration Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by flowing ossifications on the anterolateral side of the thoracic spine with relative preservation of the intervertebral disc (IVD). 1 The new bone formation is most frequently observed on the right side of the thoracic spine, and aortic pulsations have been suggested to prevent ossification on the left side. 2 The prevalence of DISH ranges from 2.9% to 42% in a general population over 50 years of age. [2][3][4] Several studies have shown a correlation between DISH and advanced age, the metabolic syndrome, and cardiovascular disease. [2][3][4] The prevalence of DISH can be expected to rise in Western societies due to increased exposure to endemic risk factors including sedentary lifestyle, obesity, and long life expectancy. 5 The clinical relevance of DISH is slowly being acknowledged as several symptoms, including stiffness of the back and joints, skeletal pain, reduced lung capacity, dysphagia, and airway obstruction have been shown to be related to DISH. 2,6,7 Furthermore, individuals with spinal ankylosis have a four-to-eight times higher risk of spinal fractures after low impact trauma compared to individuals with a non-ankylotic spine. 8,9 Although the pathogenesis ...

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“…Dysphagia is the commonest complaint (Barsamian et al, 1985) and a number of case reports regarding this complaint have been documented in the literature under various surgical specialities (Meeks and Renshaw, 1973;Barsamian et al, 1985;Brandenberg and Leibrock, 1986). However, stridor secondary to osteophyte compression has rarely been documented.…”

Section: Introductionmentioning

confidence: 99%

An unusual case of stridor due to osteophytes of the cervical spine: (Forestier's disease)

et al. 1999

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Stridor is a noisy breathing caused by compromised airway in the larynx and trachea. The causes can either be due to intrinsic or extrinsic compression. Stridor resulting from extrinsic compression due to anterior cervical osteophytes is rare.We report an unusual case of acute stridor due to an osteophytic mass in the cervical vertebrae resulting in a mechanical upper airway obstruction. The underlying pathology was Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH). Stridor is a rare manifestation of DISH and it certainly represents the most lifethreatening one. Only a few cases have been reported in the English literature and are mainly secondary to impaired function of the vocal folds, or postcricoid ulceration and oedema. We present such a case, in that stridor was the result of direct airway obstruction by the osteophytic mass and an emergency tracheostomy had to be performed to establish an airway.

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Radiographic, clinical, and histopathologic evaluation with surgical treatment of Forestier's disease

Cited by 16 publications

References 5 publications

Dystrophic calcification and heterotopic ossification in fibrocartilaginous tissues of the spine in diffuse idiopathic skeletal hyperostosis (DISH)

Dystrophic calcification and heterotopic ossification in fibrocartilaginous tissues of the spine in diffuse idiopathic skeletal hyperostosis (DISH)

Histological characteristics of diffuse idiopathic skeletal hyperostosis

An unusual case of stridor due to osteophytes of the cervical spine: (Forestier's disease)

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