Diffuse idiopathic skeletal hyperostosis is associated with lumbar spinal stenosis requiring surgery
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Factors related to the onset and progression of lumbar spinal stenosis (LSS) have not yet been identified. Diffuse idiopathic skeletal hyperostosis (DISH) increases mechanical loading on the non-fused lumbar levels and may therefore lead to LSS. This cross-sectional study aimed to identify associations between LSS and DISH. This study included 2363 consecutive patients undergoing surgery for LSS and 787 general inhabitants without symptoms of LSS as participants of the population-based cohort study, Research on Osteoarthritis/Osteoporosis Against Disability. Standing whole-spine radiographs were used to diagnose DISH based on the criteria proposed by Resnick and Niwayama. The prevalence of DISH showed a significant step-wise increase among asymptomatic inhabitants without radiographic LSS, asymptomatic inhabitants with radiographic LSS, and patients with LSS requiring surgery (14.4, 21.1, and 31.7%, respectively; p < 0.001). The distribution of DISH was similar between the groups, but the lower thoracic and upper-middle lumbar spine regions were more frequently involved in patients with LSS requiring surgery. Multivariate analysis indicated that DISH was an independent associated factor for LSS requiring surgery (adjusted odds ratio 1.65; 95% confidence interval 1.32–2.07) after adjustment for age, sex, body mass index, and diabetes mellitus. Among patients with LSS requiring surgery, a higher occurrence of stenosis at the upper lumbar levels and multi-level stenosis were observed in patients with DISH requiring surgery than in patients without DISH. In conclusion, DISH is independently associated with LSS requiring surgery. The decrease in the lower mobile segments by DISH may increase the onset or severity of LSS.
KeywordsDiffuse idiopathic skeletal hyperostosis Lumbar spinal stenosis General inhabitants Prevalence Standing whole-spine radiographs
The authors wish to thank Dr. Shinji Takahashi, MD, PhD, for statistical assistance. The authors also thank Ms. Tomoko Takijiri and other members of the Public Office in Hidakagawa Town, and Ms. Tamako Tsutsumi, Ms. Kanami Maeda, and other members of the Public Office in Taiji Town, for their assistance in locating and scheduling participants for examinations for the Wakayama Spine Study.
Compliance with ethical standards
Conflict of interest
This study was supported by Grants-in-Aid for Scientific Research (B20390182, B23390357, B26860419, C20591737, C20591774, and C26462249), for Young Scientists (A18689031), and for Exploratory Research (19659305) from the Japanese Ministry of Education, Culture, Sports, Science and Technology; H17-Men-eki-009, H18-Choujyu-037, and H20-Choujyu-009 from the Ministry of Health, Labour and Welfare; Research Aid from the Japanese Orthopaedic Association; Grants from the Japanese Orthopaedics and Traumatology Foundation, Inc. (nos. 166 and 256); and a Grant-in-Aid for Scientific Research (C22591639) from the Japanese Society for the Promotion of Science. The sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. Funding was provided by the Japan Osteoporosis Society and Wakayama Medical Award for Young Researchers.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards in the Wajokai Eniwa Hospital and Wakayama Medical University.
- 3.Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2013) Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthr Cartil 21:783–788CrossRefGoogle Scholar
- 8.Sairyo K, Biyani A, Goel V, Leaman D, Booth R Jr, Thomas J, Gehling D, Vishnubhotla L, Long R, Ebraheim N (2005) Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments. Spine (Phila Pa 1976) 30:2649–2656CrossRefGoogle Scholar
- 12.North American Spine Society Clinical Guidelines. Diagnosis and treatment of degenerative lumbar spinal stenosis https://www.spine.org/Portals/0/Documents/ResearchClinicalCare/Guidelines/LumbarStenosis.pdf. Accessed 9 June 2016
- 20.Nardo L, Lane NE, Parimi N, Cawthon PM, Fan B, Shepherd J, Cauley J, Zucker-Levin A, Murphy RA, Katzman WB (2014) Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: a cross-sectional study for the Health Aging and Body Composition Study. Spine (Phila Pa 1976) 39:E1418–E1424CrossRefGoogle Scholar
- 21.Tsukahara S, Miyazawa N, Akagawa H, Forejtova S, Pavelka K, Tanaka T, Toh S, Tajima A, Akiyama I, Inoue I (2005) COL6A1, the candidate gene for ossification of the posterior longitudinal ligament, is associated with diffuse idiopathic skeletal hyperostosis in Japanese. Spine (Phila Pa 1976) 30:2321–2324CrossRefGoogle Scholar
- 22.Warraich S, Bone DB, Quinonez D, Ii H, Choi DS, Holdsworth DW, Drangova M, Dixon SJ, Seguin CA, Hammond JR (2013) Loss of equilibrative nucleoside transporter 1 in mice leads to progressive ectopic mineralization of spinal tissues resembling diffuse idiopathic skeletal hyperostosis in humans. J Bone Miner Res 28:1135–1149CrossRefGoogle Scholar
- 24.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 31:2032–2035Google Scholar
- 25.Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC (2008) The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in The Netherlands. J Rheumatol 35:1635–1638Google Scholar
- 26.Kagotani R, Yoshida M, Muraki S, Oka H, Hashizume H, Yamada H, Enyo Y, Nagata K, Ishimoto Y, Teraguchi M, Tanaka S, Nakamura K, Kawaguchi H, Akune T, Yoshimura N (2015) Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study. J Bone Miner Metab 33:221–229CrossRefGoogle Scholar
- 28.Mata S, Hill RO, Joseph L, Kaplan P, Dussault R, Watts CS, Fitzcharles MA, Shiroky JB, Fortin PR, Esdaile JM (1993) Chest radiographs as a screening test for diffuse idiopathic skeletal hyperostosis. J Rheumatol 20:1905–1910Google Scholar
- 29.Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Tanaka S, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2017) Association of lumbar spondylolisthesis with low back pain and symptomatic lumbar spinal stenosis in a population-based cohort: the Wakayama Spine Study. Spine 42:E666–E671CrossRefGoogle Scholar