Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine*,**

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Abstract

Objectives: To describe the clinical manifestations and the complications of cervical spine (C-spine) involvement in diffuse idiopathic skeletal hyperostosis (DISH). Methods: Two patients, who presented with dysphagia resulting from large anterior osteophytes of the C-spine, were diagnosed as having DISH. A Medline search from 1964 to present, using the terms “diffuse idiopathic skeletal hyperostosis” and “cervical spine,” identified several clinical manifestations associated with DISH. Results: Two groups of conditions associated with DISH were found. 1. Spontaneous complications such as: dysphagia, being the commonest, dyspnea, stridor, myelopathy associated with ossification of the posterior longitudinal ligament (OPLL) or with atlanto-axial pseudoarthrosis or subluxation. Other rare events were aspiration pneumonia, sleep apnea and thoracic outlet syndrome. 2. Provoked complications such as endoscopic and intubation difficulties and fractures of the C-spine with frequent transverse shift of the fractured segment and resultant myelopathy. Conclusions: C-spine involvement in DISH is a recognized cause of various clinical manifestations involving the pharynx, larynx and the esophagus. Prior knowledge of the existence of cervical DISH should alert the clinicians for possible complications, at times severe, during invasive procedures in the neck region and as a consequence of trauma. Semin Arthritis Rheum 32:130-135. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Methods

A Medline search from 1964 to date was performed. The initial screening used the terms “diffuse idiopathic skeletal hyperostosis” and “cervical spine.” All the reported clinical manifestations, either major or minor, associated with these 2 conditions were crossed referenced again with “diffuse idiopathic skeletal hyperostosis.” Information previous to the years of the search was gathered from the reference lists of more recent studies.

Discussion

DISH is a disease characterized by ossification and calcification of soft tissues, mainly entheses and ligaments. The thoracic spine is most often affected with flowing osteophytes involving usually the right lateral aspects of the vertebral bodies and the ALL. Other entheseal regions in the peripheral joints may be affected such as the peripatellar ligaments, the Achilles tendon insertion, the plantar fascia, and the olecranon. Because the disease affects mainly older individuals,

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    *

    Address reprint requests to Reuven Mader, MD, Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel. E-mail: [email protected]

    **

    Reuven Mader, MD: Head, Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula, and Senior Clinical Lecturer, The B. Rappaport Faculty of Medicine, The Technion, Haifa, Israel.

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