Abstract
Purpose
To elucidate the effect of diffuse idiopathic skeletal hyperostosis (DISH) on the clinical results of short-segment lumbar interbody fusion (LIF) for the treatment of degenerative lumbar spinal diseases.
Methods
The 208 patients who underwent one- or two-level LIF were selected as the subjects of this study. Patients with prior lumbar fusion surgery or follow-up <1 year were excluded. Outcome measures were surgery-free survival or the need for further surgery for pseudoarthrosis and/or adjacent segment disease (ASD). The Cox proportional-hazards model was used to identify possible risk factors (DISH, age, sex, number of levels fused, level of the lowest instrumented vertebra, and laminectomy adjacent to the index fused levels) for further surgery.
Results
Among the 208 patients (39 with DISH), 21 patients required further surgery during follow-up. Cox analysis showed that DISH (hazard ratio = 5.46) and two-level fusion (hazard ratio = 2.83) were significant independent predictors of further surgery. Age, sex, level of the lowest instrumented vertebra, and laminectomy adjacent to the index fused levels were not significant predictors.
Conclusions
DISH after short-segment LIF surgery is a significant risk factor for further surgery because of pseudoarthrosis or ASD.
Similar content being viewed by others
References
Greiner-Perth R, Boehm H, Allam Y et al (2004) Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases. Spine 29:2516–2520
Sears WR, Sergides IG, Kazemi N et al (2011) Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J 11:11–20
Etebar S, Cahill DW (1999) Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 90:163–169
Forestier J, Lagier R (1971) Ankylosing hyperostosis of the spine. Clin Orthop Relat Res 74:65–83
Resnick D, Niwayama G (1976) Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 119:559–568
Mosher HP (1926) Exostoses of the cervical vertebrae as a cause for difficulty in swallowing. The Laryngoscope 36:181–182
Diederichs G, Engelken F, Marshall LM et al (2011) Diffuse idiopathic skeletal hyperostosis (DISH): relation to vertebral fractures and bone density. Osteoporos Int 22:1789–1797
Al-Herz A, Snip JP, Clark B et al (2008) Exercise therapy for patients with diffuse idiopathic skeletal hyperostosis. Clin Rheumatol 27:207–210
Wiltse LL (1973) The paraspinal sacrospinalis-splitting approach to the lumbar spine. Clin Orthop Relat Res 91:48–57
Mata S, Chhem RK, Fortin PR et al (1998) Comprehensive radiographic evaluation of diffuse idiopathic skeletal hyperostosis: development and interrater reliability of a scoring system. Semin Arthritis Rheum 28:88–96
Grambsch PM, Therneau TM (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81:515–526
Carlson ML, Archibald DJ, Graner DE et al (2011) Surgical management of dysphagia and airway obstruction in patients with prominent ventral cervical osteophytes. Dysphagia 26:34–40
Mader R (2002) Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum 32:130–135
Bransford RJ, Koller H, Caron T et al (2012) Cervical spine trauma in diffuse idiopathic skeletal hyperostosis: injury characteristics and outcome with surgical treatment. Spine 37:1923–1932
Mader R, Novofestovski I, Adawi M et al (2009) Metabolic syndrome and cardiovascular risk in patients with diffuse idiopathic skeletal hyperostosis. Semin Arthritis Rheum 38:361–365
Mader R, Dubenski N, Lavi I (2005) Morbidity and mortality of hospitalized patients with diffuse idiopathic skeletal hyperostosis. Rheumatol Int 26:132–136
Chi D, Miyamoto K, Hosoe H et al (2008) Symptomatic lumbar mobile segment with spinal canal stenosis in a fused spine associated with diffused idiopathic skeletal hyperostosis. Spine J 8:1019–1023
Ghiselli G, Wang JC, Bhatia NN et al (2004) Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg 86-A:1497–1503
Gercek E, Hartmann F, Kuhn S et al (2008) Dynamic angular three-dimensional measurement of multisegmental thoracolumbar motion in vivo. Spine 33:2326–2333
Gillet P (2003) The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech 16:338–345
Min JH, Jang JS, Jung B et al (2008) The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech 21:305–309
Mannion AF, Fekete TF, Porchet F et al (2014) The influence of comorbidity on the risks and benefits of spine surgery for degenerative lumbar disorders. Eur Spine J 23(Suppl 1):S66–S71
Disch AC, Schmoelz W, Matziolis G et al (2008) Higher risk of adjacent segment degeneration after floating fusions: long-term outcome after low lumbar spine fusions. J Spinal Disord Tech 21:79–85
Holton KF, Denard PJ, Yoo JU et al (2011) Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum 41:131–138
Conflict of interest
No conflicts of interest are declared, and no funds were received in support of this work.
Ethical standard
This study was performed with the approval of the institutional ethics committee of Kyoto University.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Otsuki, B., Fujibayashi, S., Takemoto, M. et al. Diffuse idiopathic skeletal hyperostosis (DISH) is a risk factor for further surgery in short-segment lumbar interbody fusion. Eur Spine J 24, 2514–2519 (2015). https://doi.org/10.1007/s00586-014-3603-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-014-3603-5