Prevalence and Distribution of Diffuse Idiopathic Skeletal Hyperostosis on Whole-spine Computed Tomography in Patients with Cervical Ossification of the Posterior Longitudinal Ligament

A Multicenter Study

Soraya Nishimura, Narihito Nagoshi, Akio Iwanami, Ayano Takeuchi, Takashi Hirai, Toshitaka Yoshii, Kazuhiro Takeuchi, Kanji Mori, Tsuyoshi Yamada, Shoji Seki, Takashi Tsuji, Kanehiro Fujiyoshi, Mitsuru Furukawa, Kanichiro Wada, Masao Koda, Takeo Furuya, Yukihiro Matsuyama, Tomohiko Hasegawa, Katsushi Takeshita, Atsushi Kimura & 17 others Masahiko Abematsu, Hirotaka Haro, Tetsuro Ohba, Masahiko Watanabe, Hiroyuki Katoh, Kei Watanabe, Hiroshi Ozawa, Haruo Kanno, Shiro Imagama, Kei Ando, Shunsuke Fujibayashi, Masashi Yamazaki, Koota Watanabe, Morio Matsumoto, Masaya Nakamura, Atsushi Okawa, Yoshiharu Kawaguchi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Study Design: This was a retrospective multicenter study. Objective: To clarify the progression of diffuse idiopathic skeletal hyperostosis (DISH) using whole-spine computed tomography in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: DISH and cervical OPLL frequently coexist, and can cause ankylosing spinal fractures due to biomechanical changes and fragility of the affected vertebrae. The epidemiology and pathophysiology of DISH occurring with cervical OPLL are unclear. Materials and Methods: We used whole-spine computed tomography to determine the prevalence of DISH in 234 patients with a diagnosis of cervical OPLL based on plain cervical radiographs. We established a novel system for grading the progression of DISH based on a cluster analysis of the DISH distribution along the spine. We calculated the correlation coefficient between this grading system and patient age. Results: The prevalence of DISH in patients with cervical OPLL was 48.7%. Patients with DISH were significantly older than those who did not have DISH (67.3 vs. 63.4 y; P=0.005). Cluster analysis classified the DISH distribution into 6 regions, based on the levels affected: C2-C5, C3-T1, C6-T5, T3-10, T8-L2, and T12-S1. DISH was observed most frequently at T3-T10. We defined a system for grading DISH progression based on the number of regions involved, from grade 0 to 6. DISH was distributed at T3-T10 in >60% of the grade 1 patients, whereas most patients with DISH at the cervical or lumbar spine were grade 4 or 5. There was a weak but significant correlation between the DISH grade and patient age. Conclusions: DISH was present in nearly half of the patients with cervical OPLL. DISH was more common in older patients. DISH developed at the thoracic level and progressed into the cervical and/or lumbar spine with age. Level of Evidence: Level III.

Original languageEnglish
JournalClinical Spine Surgery
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Diffuse Idiopathic Skeletal Hyperostosis
Ossification of Posterior Longitudinal Ligament
Multicenter Studies
Spine
Tomography
Cluster Analysis
Spinal Fractures

Keywords

  • cervical ossification of the posterior longitudinal ligament
  • cluster analysis
  • diffuse idiopathic skeletal hyperostosis
  • multicenter study
  • whole-spine computed tomography

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Prevalence and Distribution of Diffuse Idiopathic Skeletal Hyperostosis on Whole-spine Computed Tomography in Patients with Cervical Ossification of the Posterior Longitudinal Ligament : A Multicenter Study. / Nishimura, Soraya; Nagoshi, Narihito; Iwanami, Akio; Takeuchi, Ayano; Hirai, Takashi; Yoshii, Toshitaka; Takeuchi, Kazuhiro; Mori, Kanji; Yamada, Tsuyoshi; Seki, Shoji; Tsuji, Takashi; Fujiyoshi, Kanehiro; Furukawa, Mitsuru; Wada, Kanichiro; Koda, Masao; Furuya, Takeo; Matsuyama, Yukihiro; Hasegawa, Tomohiko; Takeshita, Katsushi; Kimura, Atsushi; Abematsu, Masahiko; Haro, Hirotaka; Ohba, Tetsuro; Watanabe, Masahiko; Katoh, Hiroyuki; Watanabe, Kei; Ozawa, Hiroshi; Kanno, Haruo; Imagama, Shiro; Ando, Kei; Fujibayashi, Shunsuke; Yamazaki, Masashi; Watanabe, Koota; Matsumoto, Morio; Nakamura, Masaya; Okawa, Atsushi; Kawaguchi, Yoshiharu.

In: Clinical Spine Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Nishimura, S, Nagoshi, N, Iwanami, A, Takeuchi, A, Hirai, T, Yoshii, T, Takeuchi, K, Mori, K, Yamada, T, Seki, S, Tsuji, T, Fujiyoshi, K, Furukawa, M, Wada, K, Koda, M, Furuya, T, Matsuyama, Y, Hasegawa, T, Takeshita, K, Kimura, A, Abematsu, M, Haro, H, Ohba, T, Watanabe, M, Katoh, H, Watanabe, K, Ozawa, H, Kanno, H, Imagama, S, Ando, K, Fujibayashi, S, Yamazaki, M, Watanabe, K, Matsumoto, M, Nakamura, M, Okawa, A & Kawaguchi, Y 2018, 'Prevalence and Distribution of Diffuse Idiopathic Skeletal Hyperostosis on Whole-spine Computed Tomography in Patients with Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Study', Clinical Spine Surgery. https://doi.org/10.1097/BSD.0000000000000701
Nishimura, Soraya ; Nagoshi, Narihito ; Iwanami, Akio ; Takeuchi, Ayano ; Hirai, Takashi ; Yoshii, Toshitaka ; Takeuchi, Kazuhiro ; Mori, Kanji ; Yamada, Tsuyoshi ; Seki, Shoji ; Tsuji, Takashi ; Fujiyoshi, Kanehiro ; Furukawa, Mitsuru ; Wada, Kanichiro ; Koda, Masao ; Furuya, Takeo ; Matsuyama, Yukihiro ; Hasegawa, Tomohiko ; Takeshita, Katsushi ; Kimura, Atsushi ; Abematsu, Masahiko ; Haro, Hirotaka ; Ohba, Tetsuro ; Watanabe, Masahiko ; Katoh, Hiroyuki ; Watanabe, Kei ; Ozawa, Hiroshi ; Kanno, Haruo ; Imagama, Shiro ; Ando, Kei ; Fujibayashi, Shunsuke ; Yamazaki, Masashi ; Watanabe, Koota ; Matsumoto, Morio ; Nakamura, Masaya ; Okawa, Atsushi ; Kawaguchi, Yoshiharu. / Prevalence and Distribution of Diffuse Idiopathic Skeletal Hyperostosis on Whole-spine Computed Tomography in Patients with Cervical Ossification of the Posterior Longitudinal Ligament : A Multicenter Study. In: Clinical Spine Surgery. 2018.
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abstract = "Study Design: This was a retrospective multicenter study. Objective: To clarify the progression of diffuse idiopathic skeletal hyperostosis (DISH) using whole-spine computed tomography in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: DISH and cervical OPLL frequently coexist, and can cause ankylosing spinal fractures due to biomechanical changes and fragility of the affected vertebrae. The epidemiology and pathophysiology of DISH occurring with cervical OPLL are unclear. Materials and Methods: We used whole-spine computed tomography to determine the prevalence of DISH in 234 patients with a diagnosis of cervical OPLL based on plain cervical radiographs. We established a novel system for grading the progression of DISH based on a cluster analysis of the DISH distribution along the spine. We calculated the correlation coefficient between this grading system and patient age. Results: The prevalence of DISH in patients with cervical OPLL was 48.7{\%}. Patients with DISH were significantly older than those who did not have DISH (67.3 vs. 63.4 y; P=0.005). Cluster analysis classified the DISH distribution into 6 regions, based on the levels affected: C2-C5, C3-T1, C6-T5, T3-10, T8-L2, and T12-S1. DISH was observed most frequently at T3-T10. We defined a system for grading DISH progression based on the number of regions involved, from grade 0 to 6. DISH was distributed at T3-T10 in >60{\%} of the grade 1 patients, whereas most patients with DISH at the cervical or lumbar spine were grade 4 or 5. There was a weak but significant correlation between the DISH grade and patient age. Conclusions: DISH was present in nearly half of the patients with cervical OPLL. DISH was more common in older patients. DISH developed at the thoracic level and progressed into the cervical and/or lumbar spine with age. Level of Evidence: Level III.",
keywords = "cervical ossification of the posterior longitudinal ligament, cluster analysis, diffuse idiopathic skeletal hyperostosis, multicenter study, whole-spine computed tomography",
author = "Soraya Nishimura and Narihito Nagoshi and Akio Iwanami and Ayano Takeuchi and Takashi Hirai and Toshitaka Yoshii and Kazuhiro Takeuchi and Kanji Mori and Tsuyoshi Yamada and Shoji Seki and Takashi Tsuji and Kanehiro Fujiyoshi and Mitsuru Furukawa and Kanichiro Wada and Masao Koda and Takeo Furuya and Yukihiro Matsuyama and Tomohiko Hasegawa and Katsushi Takeshita and Atsushi Kimura and Masahiko Abematsu and Hirotaka Haro and Tetsuro Ohba and Masahiko Watanabe and Hiroyuki Katoh and Kei Watanabe and Hiroshi Ozawa and Haruo Kanno and Shiro Imagama and Kei Ando and Shunsuke Fujibayashi and Masashi Yamazaki and Koota Watanabe and Morio Matsumoto and Masaya Nakamura and Atsushi Okawa and Yoshiharu Kawaguchi",
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TY - JOUR

T1 - Prevalence and Distribution of Diffuse Idiopathic Skeletal Hyperostosis on Whole-spine Computed Tomography in Patients with Cervical Ossification of the Posterior Longitudinal Ligament

T2 - A Multicenter Study

AU - Nishimura, Soraya

AU - Nagoshi, Narihito

AU - Iwanami, Akio

AU - Takeuchi, Ayano

AU - Hirai, Takashi

AU - Yoshii, Toshitaka

AU - Takeuchi, Kazuhiro

AU - Mori, Kanji

AU - Yamada, Tsuyoshi

AU - Seki, Shoji

AU - Tsuji, Takashi

AU - Fujiyoshi, Kanehiro

AU - Furukawa, Mitsuru

AU - Wada, Kanichiro

AU - Koda, Masao

AU - Furuya, Takeo

AU - Matsuyama, Yukihiro

AU - Hasegawa, Tomohiko

AU - Takeshita, Katsushi

AU - Kimura, Atsushi

AU - Abematsu, Masahiko

AU - Haro, Hirotaka

AU - Ohba, Tetsuro

AU - Watanabe, Masahiko

AU - Katoh, Hiroyuki

AU - Watanabe, Kei

AU - Ozawa, Hiroshi

AU - Kanno, Haruo

AU - Imagama, Shiro

AU - Ando, Kei

AU - Fujibayashi, Shunsuke

AU - Yamazaki, Masashi

AU - Watanabe, Koota

AU - Matsumoto, Morio

AU - Nakamura, Masaya

AU - Okawa, Atsushi

AU - Kawaguchi, Yoshiharu

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Study Design: This was a retrospective multicenter study. Objective: To clarify the progression of diffuse idiopathic skeletal hyperostosis (DISH) using whole-spine computed tomography in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: DISH and cervical OPLL frequently coexist, and can cause ankylosing spinal fractures due to biomechanical changes and fragility of the affected vertebrae. The epidemiology and pathophysiology of DISH occurring with cervical OPLL are unclear. Materials and Methods: We used whole-spine computed tomography to determine the prevalence of DISH in 234 patients with a diagnosis of cervical OPLL based on plain cervical radiographs. We established a novel system for grading the progression of DISH based on a cluster analysis of the DISH distribution along the spine. We calculated the correlation coefficient between this grading system and patient age. Results: The prevalence of DISH in patients with cervical OPLL was 48.7%. Patients with DISH were significantly older than those who did not have DISH (67.3 vs. 63.4 y; P=0.005). Cluster analysis classified the DISH distribution into 6 regions, based on the levels affected: C2-C5, C3-T1, C6-T5, T3-10, T8-L2, and T12-S1. DISH was observed most frequently at T3-T10. We defined a system for grading DISH progression based on the number of regions involved, from grade 0 to 6. DISH was distributed at T3-T10 in >60% of the grade 1 patients, whereas most patients with DISH at the cervical or lumbar spine were grade 4 or 5. There was a weak but significant correlation between the DISH grade and patient age. Conclusions: DISH was present in nearly half of the patients with cervical OPLL. DISH was more common in older patients. DISH developed at the thoracic level and progressed into the cervical and/or lumbar spine with age. Level of Evidence: Level III.

AB - Study Design: This was a retrospective multicenter study. Objective: To clarify the progression of diffuse idiopathic skeletal hyperostosis (DISH) using whole-spine computed tomography in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: DISH and cervical OPLL frequently coexist, and can cause ankylosing spinal fractures due to biomechanical changes and fragility of the affected vertebrae. The epidemiology and pathophysiology of DISH occurring with cervical OPLL are unclear. Materials and Methods: We used whole-spine computed tomography to determine the prevalence of DISH in 234 patients with a diagnosis of cervical OPLL based on plain cervical radiographs. We established a novel system for grading the progression of DISH based on a cluster analysis of the DISH distribution along the spine. We calculated the correlation coefficient between this grading system and patient age. Results: The prevalence of DISH in patients with cervical OPLL was 48.7%. Patients with DISH were significantly older than those who did not have DISH (67.3 vs. 63.4 y; P=0.005). Cluster analysis classified the DISH distribution into 6 regions, based on the levels affected: C2-C5, C3-T1, C6-T5, T3-10, T8-L2, and T12-S1. DISH was observed most frequently at T3-T10. We defined a system for grading DISH progression based on the number of regions involved, from grade 0 to 6. DISH was distributed at T3-T10 in >60% of the grade 1 patients, whereas most patients with DISH at the cervical or lumbar spine were grade 4 or 5. There was a weak but significant correlation between the DISH grade and patient age. Conclusions: DISH was present in nearly half of the patients with cervical OPLL. DISH was more common in older patients. DISH developed at the thoracic level and progressed into the cervical and/or lumbar spine with age. Level of Evidence: Level III.

KW - cervical ossification of the posterior longitudinal ligament

KW - cluster analysis

KW - diffuse idiopathic skeletal hyperostosis

KW - multicenter study

KW - whole-spine computed tomography

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DO - 10.1097/BSD.0000000000000701

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JO - Clinical Spine Surgery

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