Fractures in Spinal Ankylosing Disorders: A Narrative Review of Disease and Injury Types, Treatment Techniques, and Outcomes. Injuries to the Rigid Spine: What the Spine Surgeon Wants to Know. (2017) American Journal of Roentgenology. CT Abnormalities in the Sacroiliac Joints of Patients With Diffuse Idiopathic Skeletal Hyperostosis. Naama Leibushor, Einat Slonimsky, Dvora Aharoni, Merav Lidar, Iris Eshed. Diffuse idiopathic skeletal hyperostosis: A review. Nascimento FA, Gatto LA, Lages RO, Neto HM, Demartini Z, Koppe GL. doi:10.4137/CMAMD.S6949 - Free text at pubmed - Pubmed citationĩ. Clin Med Insights Arthritis Musculoskelet Disord. Diffuse Idiopathic Skeletal Hyperostosis (DISH)-A Rare Etiology of Dysphagia. Krishnarasa B, Vivekanandarajah A, Ripoll L et-al. If seen in a child, consider juvenile idiopathic arthritis (JIA)Ĩ. Predominantly involves the cervical spineįluorite intoxication due to long-term ingestionĬan cause paraspinal ligament calcification Patients using retinoid acid for skin diseases Usually, the anterior longitudinal ligament of the thoracic spine is not affected 9 Usually has prominent facet and apophyseal joints degenerative changes as well Sacroiliac joint involvement early on and is in the synovial portion (inferior two-thirds) Syndesmophytes: thinner, form over the annulus, and are vertically oriented (" bamboo spine") Note that fractures can also occur above or below the rigid segment due to altered biomechanicsĭysphagia is reported in ~28% of cases involving the cervical spine 12, which may be caused by mechanical compression due to anterior cervical bone production 8Ĭervical DISH can make intubation more difficult 11 Inspect the ossified ligaments for disruption, and compare with prior imaging where available to discern fracture from a region without ossification Possible complications may require specific treatment:Īcute spinal fractures in low impact trauma Spur formation in the appendicular skeleton (olecranon, calcaneum, patellar ligament) frequently presentĭISH is generally managed clinically with analgesics and non-steroidal anti-inflammatory drugs when pain and stiffness are related. No sacroiliitis or facet joint ankylosis although sacroiliac joint anterior bridging, posterior bridging, entheseal bridging may be present 10Įnthesopathy of the iliac crest, ischial tuberosities, and greater trochanters For the same reason, the right lateral aspect is spared in situs inversus 5.Īnkylosis is more common in the thoracic than cervical or lumbar spineĬan have interdigitating areas of protruding disc material in the flowing ossifications The left lateral aspect is usually spared in the thoracolumbar spine, thought due to aortic pulsation inhibiting ossification 5. Radiographic features Plain radiograph and CT Spinal featuresįlowing ossifications: florid, flowing ossification along the anterior or right 7 aspects of at least four contiguous vertebrae. Additionally, enthesopathy may be identified in the pelvis and extremities. The cervical and thoracic (particularly T7-11 5) spines, in particular, are affected. Periosteal new bone formation on the anterior surface of the vertebral bodies Paraspinal connective tissue and annulus fibrosusĭegeneration of the peripheral annulus fibrosus fibersĪnterolateral extensions of fibrous tissueĬhronic inflammatory cellular infiltration Histopathological features of spinal DISH include 5:įocal and diffuse calcification and ossification of the anterior longitudinal ligament However, spine stiffness and decreased mobility are referred to as possible symptoms. The condition is commonly identified as an incidental finding when imaging for other reasons. Ossification of the posterior longitudinal ligament, which may be a cause of spinal stenosisĪpproximately one-third of patients test positive for HLA-B27 The estimated frequency in the elderly is ~10% 6, with a male predominance. DISH most commonly affects the elderly, especially 6 th to 7 th decades 3.
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