Diffuse Idiopathic Skeletal Hyperostosis of Cervical Column: a Clinical Anatomy and Functional Approach

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Abstract

Diffuse Idiopathic Skeletal Hyperostosis is a condition of unknown cause, characterized by calcification and ossification of entheseal sites, which generally causes ankylosis of the spinal column and ossification of the extra-spinal ligaments or tendons. The case reported is from the cervical region of the spinal column of skeletal remains. Knowledge of the multiple clinical and functional implications analyzed is of great importance when approaching patients with said manifestations.

Translated abstract

La hiperostosis esquelética difusa idiopática es una afección de causa desconocida, caracterizada por calcificación y osificación de sitios de entesis, que generalmente ocasiona anquilosis de la columna vertebral y osificación de ligamentos o tendones. El caso reportado es a partir de la región cervical de la columna vertebral de un resto esquelético. El conocimiento de las múltiples implicaciones clínicas y funcionales analizadas es de gran importancia para el momento del abordaje de pacientes con dichas manifestaciones.

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Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine.

Reuven Mader (2002)

To describe the clinical manifestations and the complications of cervical spine (C-spine) involvement in diffuse idiopathic skeletal hyperostosis (DISH). 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. 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. 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. Copyright 2002, Elsevier Science (USA). All rights reserved.

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Stages of epiphyseal union for thoracic and lumbar vertebral centra as a method of age determination for teenage and young adult skeletons.

A. Albert, W Maples (1995)

Many current methods of age determination available to forensic anthropologists are limiting in that the age ranges provided are often broad, particularly for individuals in their late teens to early 20's. This study introduces an improved method for aging teenagers and young adults. The pattern and stages of union of the superior and inferior epiphyses of the vertebral centra (or ring epiphyses) were examined in 55 individuals, females and males, black and white, between ages 11 and 32 years. Vertebral ring epiphyseal union was found to be a good predictor of age. The correlation between stages of union and known age was 0.78 (P < .0001). The standard deviation was 2.566 years at the 99.9% confidence level. Sex differences were observed, but were not statistically significant. A larger sample size may perhaps demonstrate statistically significant differences in sex, and may or may not yield differences in race. A preliminary interobserver bias test showed high replicability. Results of this study compare favorably with results of other aging studies. Current age information for the progress of vertebral ring epiphyseal union is supplied for young males--and for the first time--females. This improved aging method provides necessary corroborative information for use with observations from other skeletal age indicators. Data collected from epiphyseal union of the vertebral centra aid in lessening the gap for early adult age determination.