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Diffuse idiopathic skeletal hyperostosis is associated with lumbar spinal stenosis requiring surgery

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Abstract

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.

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References

  1. Katz JN, Harris MB (2008) Clinical practice. Lumbar spinal stenosis. N Engl J Med 358:818–825

    Article  CAS  PubMed  Google Scholar 

  2. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Jt Surg Am 72:403–408

    Article  CAS  Google Scholar 

  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 21:783–788

    Article  CAS  PubMed  Google Scholar 

  4. Uesugi K, Sekiguchi M, Kikuchi S, Konno S (2013) Relationship between lumbar spinal stenosis and lifestyle-related disorders: a cross-sectional multicenter observational study. Spine (Phila Pa 1976) 38:E540–E545

    Article  Google Scholar 

  5. Yabuki S, Fukumori N, Takegami M, Onishi Y, Otani K, Sekiguchi M, Wakita T, Kikuchi S, Fukuhara S, Konno S (2013) Prevalence of lumbar spinal stenosis, using the diagnostic support tool, and correlated factors in Japan: a population-based study. J Orthop Sci 18:893–900

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yaniv G, Bader S, Lidar M, Herman A, Shazar N, Aharoni D, Eshed I (2014) The natural course of bridging osteophyte formation in diffuse idiopathic skeletal hyperostosis: retrospective analysis of consecutive CT examinations over 10 years. Rheumatology (Oxford) 53:1951–1957

    Article  Google Scholar 

  7. Resnick D, Niwayama G (1976) Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 119:559–568

    Article  CAS  PubMed  Google 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) 30:2649–2656

    Article  Google Scholar 

  9. Karpman RR, Weinstein PR, Gall EP, Johnson PC (1982) Lumbar spinal stenosis in a patient with diffuse idiopathic skeletal hypertrophy syndrome. Spine (Phila Pa 1976) 7:598–603

    Article  CAS  Google Scholar 

  10. Yamada K, Toyoda H, Terai H, Takahashi S, Nakamura H (2014) Spinopelvic alignment of diffuse idiopathic skeletal hyperostosis in lumbar spinal stenosis. Eur Spine J 23:1302–1308

    Article  PubMed  Google Scholar 

  11. Yoshimura N, Muraki S, Oka H, Kawaguchi H, Nakamura K, Akune T (2010) Cohort profile: research on osteoarthritis/osteoporosis against disability study. Int J Epidemiol 39:988–995

    Article  PubMed  Google 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

  13. Suri P, Rainville J, Kalichman L, Katz JN (2010) Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis? JAMA 304:2628–2636

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Forestier J, Rotes-Querol J (1950) Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 9:321–330

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Mader R (2002) Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum 32:130–135

    Article  PubMed  Google Scholar 

  16. Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 18:145–156

    Article  CAS  PubMed  Google Scholar 

  17. Nachemson AL (1981) Disc pressure measurements. Spine (Phila Pa 1976) 6:93–97

    Article  CAS  Google Scholar 

  18. Putzer M, Auer S, Malpica W, Suess F, Dendorfer S (2016) A numerical study to determine the effect of ligament stiffness on kinematics of the lumbar spine during flexion. BMC Musculoskelet Disord 17:95. https://doi.org/10.1186/s12891-016-0942-x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hirano K, Imagama S, Hasegawa Y, Muramoto A, Ishiguro N (2013) Impact of spinal imbalance and BMI on lumbar spinal canal stenosis determined by a diagnostic support tool: cohort study in community living people. Arch Orthop Trauma Surg 133:1477–1482

    Article  PubMed  Google Scholar 

  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–E1424

    Article  Google 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) 30:2321–2324

    Article  Google 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 28:1135–1149

    Article  CAS  PubMed  Google Scholar 

  23. Weinfeld RM, Olson PN, Maki DD, Griffiths HJ (1997) The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skelet Radiol 26:222–225

    Article  CAS  Google 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 31:2032–2035

    PubMed  Google 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 35:1635–1638

    PubMed  Google 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 33:221–229

    Article  CAS  PubMed  Google Scholar 

  27. Julkunen H, Heinonen OP, Pyorala K (1971) Hyperostosis of the spine in an adult population. Its relation to hyperglycaemia and obesity. Ann Rheum Dis 30:605–612

    Article  CAS  PubMed  PubMed Central  Google 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 20:1905–1910

    CAS  PubMed  Google 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–E671

    Article  PubMed  Google Scholar 

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Hokkaido, Japan

    Kentaro Yamada, Shigenobu Satoh, Yuichiro Abe & Takeshi Masuda

  2. Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Kentaro Yamada, Hiromitsu Toyoda, Hidetomi Terai & Hiroaki Nakamura

  3. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan

    Hiroshi Hashizume, Ryohei Kagotani, Yuyu Ishimoto & Munehito Yoshida

  4. Department of Joint Disease Research, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan

    Noriko Yoshimura & Shigeyuki Muraki

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  1. Kentaro Yamada
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  2. Shigenobu Satoh
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  3. Hiroshi Hashizume
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  13. Munehito Yoshida
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Corresponding author

Correspondence to Kentaro Yamada.

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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.

Ethical approval

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.

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Yamada, K., Satoh, S., Hashizume, H. et al. Diffuse idiopathic skeletal hyperostosis is associated with lumbar spinal stenosis requiring surgery. J Bone Miner Metab 37, 118–124 (2019). https://doi.org/10.1007/s00774-017-0901-0

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  • DOI: https://doi.org/10.1007/s00774-017-0901-0

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