Clin Orthop Surg.  2018 Mar;10(1):41-46. 10.4055/cios.2018.10.1.41.

Prevalence of Diffuse Idiopathic Skeletal Hyperostosis Diagnosed by Whole Spine Computed Tomography: A Preliminary Study

• Kim BS
• Moon MS
• Yoon MG
• Kim ST
• Kim SJ
• Kim MS
• Kim DS

• KMID: 2405481
• DOI: http://doi.org/10.4055/cios.2018.10.1.41

Abstract

BACKGROUND
Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of the enthesis. The diagnosis has been mainly based on the chest or whole spine lateral plain film. Recently, chest or thoracolumbar computed tomography (CT) has been reported to be more reliable for the diagnosis of DISH. The purposes of this study were to investigate the prevalence and location of DISH and evaluate the prevalence of comorbidities, such as ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), using whole spine CT.
METHODS
Whole spine CT scans of patients over 16 years of age who were examined at Cheju Halla General Hospital between February 2011 and December 2016 were reviewed for this study. The diagnosis of DISH was made according to the modified Resnick criteria. The prevalence of DISH in each age decade and its location were evaluated. Also, the prevalence of OPLL and OLF in DISH patients was investigated.
RESULTS
The overall incidence of DISH was 24.4% (40 of 164 cases). There was no case of DISH in patients in their 40s and younger. The percentile incidences of DISH in patients in their fifth, sixth, seventh, eighth, and ninth decades were 20.0% (4 of 20 cases), 32.3% (10 of 31 cases), 40.0% (10 of 25 cases), 34.5% (10 of 29 cases), and 27.3% (6 of 22 cases), respectively. A strong positive correlation between the age decade and the incidence of DISH was noted (r = 0.853, p = 0.007). DISH patients had higher incidences of OLF (22.5%) and OPLL (37.5%). The most common location of DISH was the middle thoracic spine (90.0%) followed by the lower thoracic spine (87.5%). There was one case of DISH involving only the cervical spine.
CONCLUSIONS
The incidence of DISH diagnosed by CT was higher than we expected. Whole spine CT can be a valuable modality to evaluate the location of DISH in the cervical and lumbar spine and the comorbidity rates of OLF and OPLL.

Keyword

Spine; Computed tomography; Hyperostosis; Diffuse idiopathic skeletal; Prevalence

MeSH Terms

Comorbidity
Diagnosis
Hospitals, General
Humans
Hyperostosis
Hyperostosis, Diffuse Idiopathic Skeletal*
Incidence
Jeju-do
Ligamentum Flavum
Longitudinal Ligaments
Prevalence*
Spine*
Thorax
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) based on whole spine computed tomography in each decade.

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  Fig. 2 A case of diffuse idiopathic skeletal hyperostosis involving only cervical spine (C3–6). Flowing bridging ossification and partial ossification (arrows) of three contiguous disc levels (C3–6) are noted in consecutive sagittal images (A, B) of whole spine computed tomography.

• 

  Fig. 3 A case of diffuse idiopathic skeletal hyperostosis involving only upper thoracic spine (T3–6). Flowing bridging ossification (arrows) of three contiguous disc levels (T3–6) is noted in a sagittal image of whole spine computed tomography.

• 

  Fig. 4 Prevalence of diffuse idiopathic skeletal hyperostosis based on whole spine computed tomography in five divided spinal regions. T: thoracic.

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