Top

European Spine Journal

Published in:

01-06-2014 | Original Article

Spinopelvic alignment of diffuse idiopathic skeletal hyperostosis in lumbar spinal stenosis

Authors: Kentaro Yamada, Hiromitsu Toyoda, Hidetomi Terai, Shinji Takahashi, Hiroaki Nakamura

Published in: European Spine Journal | Issue 6/2014

Abstract

Purpose

The effect of diffuse idiopathic skeletal hyperostosis (DISH) on spinopelvic alignment in patients with lumbar spinal stenosis (LSS) remains unclear. The aim of this study was to investigate the association between DISH and sagittal spinopelvic alignment in patients undergoing surgery for LSS.

Methods

A total of 132 patients aged >40 years who required surgical procedures for LSS were investigated. DISH was defined by Resnick’s and Mata’s criteria on preoperative standing whole-spine radiographs. We investigated the prevalence and localization of DISH and its relation to preoperative clinical symptoms. Spinopelvic alignment was measured by the sagittal C7 plumb line, lumbar lordosis, thoracic kyphosis, and pelvic parameters. The association between DISH and spinopelvic alignment was analyzed using covariance adjustment for age, sex, spondylolisthesis, and degenerative lumbar scoliosis.

Results

The prevalence of DISH was 39.4 % and increased with age. Preoperative symptoms showed no differences, regardless of the presence of DISH. Lumbar and thoracic alignment showed kyphotic change in patients with DISH. Patients with DISH with lower fused vertebral ends at the lumbar level (46 % of DISH) still showed significantly decreased lumbar lordosis (p = 0.014) and decreased sacral slope (p = 0.001) after adjusting for age, sex, spondylolisthesis, and degenerative lumbar scoliosis.

Conclusions

The prevalence of DISH in patients with LSS was relatively high. Spinopelvic alignment is affected by the presence of DISH, especially in patients with lower fused vertebral ends at the lumbar lesion. These results may offer an explanation for the frequent kyphotic changes in the spine of elderly patients.

Forestier J, Rotes-Querol J (1950) Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 9(4):321–330PubMedCentralPubMedCrossRef

Resnick D, Shaul SR, Robins JM (1975) Diffuse idiopathic skeletal hyperostosis (DISH): Forestier’s disease with extraspinal manifestations. Radiology 115(3):513–524PubMed

Kim SK, Choi BR, Kim CG, Chung SH, Choe JY, Joo KB, Bae SC, Yoo DH, Jun JB (2004) The prevalence of diffuse idiopathic skeletal hyperostosis in Korea. J Rheumatol 31(10):2032–2035PubMed

Weinfeld RM, Olson PN, Maki DD, Griffiths HJ (1997) The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skelet Radiol 26(4):222–225CrossRef

Kiss C, O’Neill TW, Mituszova M, Szilagyi M, Poor G (2002) The prevalence of diffuse idiopathic skeletal hyperostosis in a population-based study in Hungary. Scand J Rheumatol 31(4):226–229PubMedCrossRef

Resnick D, Dwosh IL, Goergen TG, Shapiro RF, Utsinger PD, Wiesner KB, Bryan BL (1976) Clinical and radiographic abnormalities in ankylosing spondylitis: a comparison of men and women. Radiology 119(2):293–297PubMed

Resnick D, Niwayama G (1976) Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 119(3):559–568PubMed

Mader R (2002) Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum 32(2):130–135PubMedCrossRef

Olivieri I, D’Angelo S, Cutro MS, Padula A, Peruz G, Montaruli M, Scarano E, Giasi V, Palazzi C, Khan MA (2007) Diffuse idiopathic skeletal hyperostosis may give the typical postural abnormalities of advanced ankylosing spondylitis. Rheumatology (Oxford, England) 46(11):1709–1711CrossRef

10.

Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20(12):1351–1358PubMedCrossRef

11.

Milne JS, Lauder IJ (1974) Age effects in kyphosis and lordosis in adults. Ann Hum Biol 1(3):327–337PubMedCrossRef

12.

Rajnics P, Templier A, Skalli W, Lavaste F, Illes T (2002) The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech 15(1):24–30PubMedCrossRef

13.

Hong JY, Suh SW, Modi HN, Hur CY, Yang JH, Song HR (2010) Correlation of pelvic orientation with adult scoliosis. J Spinal Disord Tech 23(7):461–466PubMedCrossRef

14.

Mata S, Chhem RK, Fortin PR, Joseph L, Esdaile JM (1998) Comprehensive radiographic evaluation of diffuse idiopathic skeletal hyperostosis: development and interrater reliability of a scoring system. Semin Arthritis Rheum 28(2):88–96PubMedCrossRef

15.

Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7(2):99–103PubMedCentralPubMedCrossRef

16.

Vedantam R, Lenke LG, Keeney JA, Bridwell KH (1998) Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine 23(2):211–215PubMedCrossRef

17.

Mader R, Novofastovski I, Rosner E, Adawi M, Herer P, Buskila D (2010) Nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis. J Rheumatol 37(9):1911–1916PubMedCrossRef

18.

Holton KF, Denard PJ, Yoo JU, Kado DM, Barrett-Connor E, Marshall LM (2011) Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum 41(2):131–138PubMedCentralPubMedCrossRef

19.

Mata S, Fortin PR, Fitzcharles MA, Starr MR, Joseph L, Watts CS, Gore B, Rosenberg E, Chhem RK, Esdaile JM (1997) A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. Medicine 76(2):104–117PubMedCrossRef

20.

Offierski CM, MacNab I (1983) Hip-spine syndrome. Spine 8(3):316–321PubMedCrossRef

21.

Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine 13(11):1317–1326PubMedCrossRef

22.

Hirose D, Ishida K, Nagano Y, Takahashi T, Yamamoto H (2004) Posture of the trunk in the sagittal plane is associated with gait in community-dwelling elderly population. Clin Biomech (Bristol, Avon) 19(1):57–63CrossRef

23.

Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19(14):1611–1618PubMedCrossRef

24.

Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C (2010) Spine fractures in patients with ankylosing spinal disorders. Spine 35(11):E458–E464PubMed

25.

Chi D, Miyamoto K, Hosoe H, Kawai G, Ohnishi K, Suzuki N, Sumi H, Shimizu K (2008) Symptomatic lumbar mobile segment with spinal canal stenosis in a fused spine associated with diffused idiopathic skeletal hyperostosis. Spine J 8(6):1019–1023PubMedCrossRef

Title: Spinopelvic alignment of diffuse idiopathic skeletal hyperostosis in lumbar spinal stenosis
Authors: Kentaro Yamada
Hiromitsu Toyoda
Hidetomi Terai
Shinji Takahashi
Hiroaki Nakamura
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 6/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-013-3154-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Spinopelvic alignment of diffuse idiopathic skeletal hyperostosis in lumbar spinal stenosis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2014

Demineralization after balloon kyphoplasty with calcium phosphate cement: a histological evaluation in ten patients

What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review

Cross-cultural adaptation of the German version of the spinal stenosis measure

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

Do vertebral derotation techniques offer better outcomes compared to traditional methods in the surgical treatment of adolescent idiopathic scoliosis?

The CT and intraoperative observation of pedicel-ossification tunnel in 151 cases of thoracic spinal stenosis from ossification of ligamentum flavum