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Radiographic and MRI characteristics of lumbar disseminated idiopathic spinal hyperostosis and spondylosis deformans in dogs
Abstract
OBJECTIVES
To evaluate clinical signs, describe lesions and differences in the magnetic resonance imaging appearance of spinal new bone formations classified as disseminated idiopathic spinal hyperostosis and/or spondylosis deformans on radiographs and compare degeneration status of the intervertebral discs using the Pfirrmann scale.METHODS
Retrospective analysis of 18 dogs presented with spinal disorders using information from radiographic and magnetic resonance imaging examinations.RESULTSAll dogs were found to be affected with both disseminated idiopathic spinal hyperostosis and spondylosis deformans. Neurological signs due to foraminal stenosis associated with disseminated idiopathic spinal hyperostosis were found in two dogs. Spondylosis deformans was associated with foraminal stenosis and/or disc protrusion in 15 cases.The Pfirrmann score on magnetic resonance imaging was significantly higher in spondylosis deformans compared with disseminated idiopathic spinal hyperostosis and signal intensity of new bone due to disseminated idiopathic spinal hyperostosis was significantly higher compared to spondylosis deformans.CLINICAL SIGNIFICANCEDifferences between disseminated idiopathic spinal hyperostosis and spondylosis deformans found on magnetic resonance imaging contribute to an increased differentiation between the two entities. Clinically relevant lesions in association with disseminated idiopathic spinal hyperostosis were rare compared to those seen with spondylosis deformans.
... Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory systemic disease with unknown aetiology that affects the axial and appendicular skeleton, characterized by ossification of soft tissues such as ligaments and insertion of tendons and capsules to bone (enthesis) (Kranenburg et al., 2010;Togni et al., 2014). It was originally described in humans (Forestier et Rotes-Querol, 1950 quoted by Mader et al., 2013) and later in other mammals, including dog and cat (Woodard et al., 1985;Bonses et al., 2016;Fernoagă et Tudor, 2017). ...
... The segmental distribution of DISH in the spine was more common in the lumbar segment and less common in the thoracic segment compared to previous studies (Kranenburg et al., 2010). Although in three cases DISH was found to extend to more than 10 vertebral segments, and in 8 cases bone production included L7 vertebra, DISH did not affect the lumbosacral junction in either case, suggesting the presence of a more mobility in this area than others (Togni et al., 2014). On the other hand, the presence of the newly formed bone and the merging of several adjacent vertebrae can lead to increased pressure in the adjacent segments and the appearance of degenerative processes (Kranenburg et al., 2011;Ortega et al., 2012;Togni et al., 2014), which can generate various clinical signs. ...
... Although in three cases DISH was found to extend to more than 10 vertebral segments, and in 8 cases bone production included L7 vertebra, DISH did not affect the lumbosacral junction in either case, suggesting the presence of a more mobility in this area than others (Togni et al., 2014). On the other hand, the presence of the newly formed bone and the merging of several adjacent vertebrae can lead to increased pressure in the adjacent segments and the appearance of degenerative processes (Kranenburg et al., 2011;Ortega et al., 2012;Togni et al., 2014), which can generate various clinical signs. It is known that in the same dog with DISH can be accompanied by spondylosis deformans (Kranenburg et al., 2011). ...
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic non-inflammatory disease of unknown aetiology affecting the axial and appendicular skeleton. The disease is characterised by calcification of soft tissues including tendons, joint capsules, and ligamentous attachments to bone. A retrospective radiographic study was conducted to investigate the presence and distribution of the DISH in dogs. For this goal were revised medical records from the radiology service of Faculty of Veterinary Medicine Bucharest for dogs that had a radiographic report that described the presence of DISH at spine level. The signalments of all dogs were taken from their medical records. From 531 dogs of 19 breeds, 11 dogs (Cross breed = 3; Rottweiler = 3; Boxer = 2; Golden retriever = 2; German shepherd = 1) were diagnosed with DISH, representing 2.07%. Of these, 5 were females and 6 males, aged between 6 and 15 years (an average of 9.81 years). Following the radiographic evaluation, a total of 74 vertebral segments affected by DISH were identified, and the number of vertebral segments affected per dogs varied between 4 and 10. In all cases, the DISH was accompanied by spondylosis deformans. Although the presence of flowing calcification in the ventral aspects of adjacent vertebral bodies is conclusive for classification as DISH, however it is recommended obtaining supplementation data through modern imaging exams on the vertebral structures.
... In small animal medicine, magnetic resonance imaging (MRI) is a common modality of diagnostic imaging [1][2][3][4][5]. In general, animals, unlike humans, undergo anaesthesia during the examination. ...
... AVP concentrations in saliva were measured in 32/73 patients (study group n = 16; control group n = 16). Here, the mean age of the study group was 5 years (range [3][4][5][6][7][8][9][10][11], that of the control group was 6 years (range 1-11). With regard to salivary AVP concentrations, these decreased in the study group, although the decrease was not statistically significant (p = 0.34); in the control group, no difference was found before and after MRI either (Fig 5). ...
The aim of the present study was to investigate whether the wearing of hearing protection has a positive influence on stress levels during an MRI examination in dogs under anaesthesia. To this end, the stress hormones cortisol and arginine vasopressin (AVP) were measured in the saliva of patients wearing hearing protection during an MRI scan, as well as in the control group without hearing protection, before and after the scan. Pulse rate and noise level were also measured during the MRI. It was shown that salivary cortisol concentrations in dogs without hearing protection increased during the MRI examination, while those in the control group with hearing protection remained the same (p<0.05). The pulse range was greater in the control group without hearing protection, although not statistically significant. The maximum loudness during the MRI examination, measured at 200 cm from the gantry, was 87 dB(A). The results on the loudness during mri scan highlight that hearing protection should always be used to minimise hearing damage and possibly the stress level for dogs.
... [1][2][3][4][5][6] Because of its superior ability to assess pathology of the soft and connective tissues changes, MRI is considered the gold standard for diagnosing compression of the nerve roots of the cauda equina. 1,[7][8][9][10] In veterinary medicine, the main diagnostic MRI criterion for lumbosacral foraminal stenosis has been periradicular fat obliteration. 1,7,11,12 This is also a diagnostic prerequisite for dorsolateral foraminotomy according to Gödde and Steffen. ...
... Other spinal and neuroforaminal pathologies of the soft tissue or bone structures in the lumbosacral foraminal zones were assessed in all neuroforamina that featured a Figure 1) 22,23 consisted of hypointense, irregular, osteophytic proliferations of the lateral boundaries near the endplates of the L7 and S1 vertebral bodies or medial aspects of the cranial articular processes of S1 in transverse 3DT1W images ( Figure 3C). 10 In sagittal reconstructed 3DT1W images the osteophytic proliferation displayed as a hypointense cortical spike partially obstructing the caudal part of the neuroforamen. Protrusion of the intervertebral disk in a craniolateral direction was recorded ( Figure 2). ...
Objective
To describe low‐field MRI findings associated with lumbosacral foraminal stenosis and radiculopathy and correlate these with clinical signs.
Study design
Retrospective study.
Animals
Client‐owned dogs (n = 240) that underwent a clinical examination and standardized MRI protocol of the lumbosacral junction.
Methods
Medical records of dogs with degenerative lumbosacral stenosis with neurological clinical evaluation and MRI of the lumbosacral junction were used to describe imaging pathologies and relate them to clinical status.
Results
In total, 480 L7 neuroforamina were evaluated. A loss of foraminal fat signal was identified in 364 of 480 neuroforamina of which 87.9% (n=320) showed also concurrent nerve root changes. Magnetic resonance imaging features of L7 radiculopathy included nerve root enlargement and hyperintensity to surrounding connective tissue in dorsal oblique gradient echo short time inversion recovery sequences and specific changes in shape, size, or position of the nerve root in transverse T1‐weighted sequences. Radiculopathy was noted as a consequence of either circumferential (entrapment) or focal (impingement) foraminal stenosis. Lateral vertebral spondylotic and intervertebral facet joint changes were the most common underlying spinal and neuroforaminal pathologies. Clinical signs were present in the ipsilateral hind leg in 85% (n = 65) of dogs with unilateral lumbosacral imaging findings.
Conclusion
A loss of foraminal fat signal was likely to be associated with L7 radiculopathy and foraminal stenosis. Unilateral lesions were generally associated with clinical signs on the ipsilateral limb.
Clinical significance
Loss of foraminal fat signal revealed by low‐field MRI should prompt the assessment of concurrent radiculopathy and underlying stenosis, and in coherence with clinical findings, when is combined with clinical findings, improves the diagnosis of lumbosacral foraminal stenosis.
... Radiologically, spondylosis deformans is characterized by osteophyte formation in the vertebral endplate and can range from small bony proliferations of the vertebral endplate to the bridging of the adjacent vertebrae (1,6,7). In cases of obvious lesions, such as spondylosis deformans that form bridges, the diagnosis can be easily made on radiographs alone; however, if the lesions are very mild, the diagnosis can be somewhat subjective. ...
Introduction
Spondylosis deformans is a non-inflammatory osteophytic reaction that develops to re-establish the stability of weakened joints between intervertebral discs. However, assessing these changes using radiography is subjective and difficult. In human medicine, attempts have been made to use artificial intelligence to accurately diagnose difficult and ambiguous diseases in medical imaging. Deep learning, a form of artificial intelligence, is most commonly used in medical imaging data analysis. It is a technique that utilizes neural networks to self-learn and extract features from data to diagnose diseases. However, no deep learning model has been developed to detect vertebral diseases in canine thoracolumbar and lumbar lateral X-ray images. Therefore, this study aimed to establish a segmentation model that automatically recognizes the vertebral body and spondylosis deformans in the thoracolumbar and lumbar lateral radiographs of dogs.
Methods
A total of 265 thoracolumbar and lumbar lateral radiographic images from 162 dogs were used to develop and evaluate the deep learning model based on the attention U-Net algorithm to segment the vertebral body and detect spondylosis deformans.
Results
When comparing the ability of the deep learning model and veterinary clinicians to recognize spondylosis deformans in the test dataset, the kappa value was 0.839, indicating an almost perfect agreement.
Conclusions
The deep learning model developed in this study is expected to automatically detect spondylosis deformans on thoracolumbar and lumbar lateral radiographs of dogs, helping to quickly and accurately identify unstable intervertebral disc space sites. Furthermore, the segmentation model developed in this study is expected to be useful for developing models that automatically recognize various vertebral and disc diseases.
... The affected animals may evoke resistance or pain response at the hyperextension of the caudal lumbar spine with lumbosacral pressure (lordosis test), tail hyperextension and the lumbosacral pressure test [113]. In small animals, MRI is the GS for the diagnosis of DLSS [124][125][126][127][128]. Pain management is the aim of conservative treatment consisting of the use of nonsteroidal anti-inflammatory drugs (NSAIDs), a change in exercise pattern and body weight reduction [120]. ...
Simple Summary
Several central and peripheral nervous system disorders are responsible for neurogenic bladder (NB) in dogs and cats. In this review, the authors summarized the neurological diseases causing neurogenic bladder comparable with human medicine. For the first time, the authors provided an overview of the epidemiology, prevalence, clinical findings, diagnosis and prognosis of the NB in dogs and cats compared with humans.
Abstract
Lower urinary tract disease (LUTD) includes abnormalities in the structure and function of the bladder and the urethra. LUTD caused by neurological disease is defined neurogenic bladder (NB). The integrity of the central nervous system (CNS) and peripheral nervous system (PNS) is required to explicate normal micturition, maintaining the proper function of bladder and urethra. The location and type of neurological lesions influence the pattern of clinical manifestations, potential treatment, and prognosis. Though, in dogs and cats, spinal cord injury is considered mainly responsible for bladder and/or urethra incompetence, other disorders, congenital or acquired, involving CNS or PNS, could play a role in NB. In veterinary medicine, the information about the epidemiology, prevalence, etiopathogenesis, diagnosis and treatment of NB are scattered. The aim of this study is to provide an overview of the epidemiology, prevalence, clinical findings, diagnosis and prognosis for NB in dogs and cats compared with humans.
... Natural cases-unknown gene Some natural cases of DISH have been observed in dogs (Kranenburg et al., 2010;Kranenburg et al., 2014;Togni et al., 2014;Bossens et al., 2016) and, as in humans, the disease is more common in older male animals and is more frequent in the boxer breed (Kranenburg et al., 2010). The high occurrence of DISH in one dog breed and the low or absence occurrence in the other breeds is suggestive of a genetic mechanism (Ostrander et al., 2000). ...
Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Ossification of the Posterior Longitudinal Ligament (OPLL) are common disorders characterized by the ossification of spinal ligaments. The cause for this ossification is currently unknown but a genetic contribution has been hypothesized. Over the last decade, many studies on the genetics of ectopic calcification disorders have been performed, mainly on OPLL. Most of these studies were based on linkage analysis and case control association studies. Animal models have provided some clues but so far, the involvement of the identified genes has not been confirmed in human cases. In the last few years, many common variants in several genes have been associated with OPLL. However, these associations have not been at definitive levels of significance and evidence of functional significance is generally modest. The current evidence suggests a multifactorial aetiopathogenesis for DISH and OPLL with a subset of cases showing a stronger genetic component.
... Tipo de letra: (predefinido) Times New Roman, 12 pt Formatou: Tipo de letra: (predefinido) Times New Roman, 12 pt of clinical signs in cases where DLSS is characterised by foraminal stenosis(Gödde and Steffen 2007, Togni et al. 2014, Worth et al. 2018).5.3.3 Stabilisation and distraction techniquesSeveral stabilisation techniques have been reported in dogs suffering from DLSS. ...
Degenerative Lumbosacral Stenosis (DLSS) is a common debilitating condition affecting dogs, describing a multifactorial syndrome arising from the compression of the cauda equina and its associated nerve roots. Typically, cases present following a protracted history of suspected lumbar pain, persistent or episodic, made evident in activities where more force is loaded at the lumbosacral joint and its associated neuroforamina. Active, working, military or agility dogs are thought to be at risk of developing DLSS. Diagnosis of DLSS relies on a compatible clinical history, exclusion of conditions with similar presentation and evidence of cauda equina compromise on diagnostic imaging. Cross-sectional imaging and particularly MRI are necessary to reach a DLSS diagnosis. A protracted, persistent or episodic history of lumbar pain, difficulties jumping and pelvic limb lameness, in the absence of overt orthopaedic disease, should alert the clinician that DLSS is possible. Foraminal stenosis has been increasingly recognised as part of the DLSS syndrome, however previous to this thesis, decompressive surgery in clinically affected dogs had only been reported in a single study. Furthermore, alternative treatments to surgery in canine degenerative lumbosacral stenosis (DLSS) remain limited and reliable predictors of outcome are lacking. This considered, this thesis aimed to: (1) review retrospectively the short and long-term outcome in a cohort of canine patients who underwent lateral foraminotomy in the treatment of lumbosacral foraminal stenosis, (2) assess the usefulness of a single epidural steroid injection (ESI) in the management of DLSS, (3) evaluate ESI as a predictor of outcome following decompressive surgery and (4) compare the outcomes of ESI and decompressive surgery. A set of hypotheses were proposed: (1) lateral foraminotomy would be a safe and useful treatment in cases of lumbosacral foraminal stenosis, (2) ESI can be effective in DLSS cases, leading to transient alleviation of clinical signs, (3) ESI can be a reliable predictor of surgical outcome, e.g. a positive response to ESI can indicate a positive response to surgical decompression, (4) surgical decompression can lead to a more favourable outcome than a single ESI. In order to address these questions two studies, one retrospective and one prospective were developed. For the first study, clinical records were reviewed retrospectively from 45 dogs which had undergone lateral foraminotomy at the lumbosacral junction either alone or in combination with decompressive midline dorsal laminectomy. For the second study, dogs diagnosed with DLSS were prospectively recruited and administered an epidural steroid injection (ESI). If clinical signs persisted or relapsed, decompressive surgery was recommended. Follow-up was obtained. Forty-five dogs were included in the retrospective study shown that short-term outcome at six weeks was assessed by the surgeon to be good (11.1 per cent) or excellent (88.9 per cent) in all 45 cases. Long-term outcome beyond six months for lumbosacral syndrome was assessed by the owner as excellent in all 34 cases for which follow-up was available despite recurrence in five cases. Recurrence of clinical signs was not related to re-establishment of foraminal compression at the surgical site when assessed on repeat MRI and was managed by either contralateral foraminotomy in one case or conservative management with excellent response. Thirty-two dogs were recruited for the prospective study that underwent ESI, with seventeen having subsequent surgery. Improvement after ESI was seen in 27/32 dogs (84.4%), with 17/22 (77.2%) relapsing within 6 months. Five dogs failed to respond to ESI and another five dogs (15.6%) presented a persistent post-ESI favourable response (mean follow-up time, 9.4 months). Post-surgical improvement was identified in all dogs. Outcome was favourable following surgical decompression, with a statistically significant difference towards reduced pain, increased mobility, and a greater quality of life score. This study was not able to demonstrate that ESI could predict surgical outcome. Concluding, the retrospective study confirmed lateral foraminotomy as an effective procedure in the management of DLSS-affected dogs suffering from foraminal stenosis and demonstrates that initial good short-term results are maintained long term despite some treatable recurrences. Lateral foraminotomy is an effective procedure when used appropriately in DLSS with foraminal stenosis either alone or in combination with midline dorsal laminectomy. The prospective study confirmed ESI as an effective treatment in most but not all cases, leading to transient alleviation of clinical signs for longer than previously reported. ESI also provided a complete and apparently long-term sustained resolution of clinical signs in a subset of dogs. Despite this, there was indication that surgical decompression could lead to a more favourable outcome. Epidural steroid injection has a role in the management of DLSS dogs, particularly when surgery is not an option. DLSS remains a field of study in clinical veterinary neurology that requires extensive work in order to stablish a more definitive classification, treatment options and outcome measures. However, the results of this thesis appear to be clinically relevant, by means of confirming the efficacy of the lateral foraminotomy procedure in cases with foraminal stenosis, as well as demonstrating that ESI has a role in the management of DLSS.
... Studies on dogs indicate that the most common spine diseases in this species are: interverteble disc disease (IVDD), especially in chondrodystrophic breeds (i.e. Dachshund, Pekingese, Spaniels, Welsh corgi, French bulldogs, Shih-tzu, Beagle) [Griffin et al. 2009, Jeffrey et al. 2013, with symptoms from mild pain to complete paralysis; degenerative lumbosacral stenosis (DLSS) in German Shepherds and Labradors [Meij and Bergknut 2010] and Spondylosis in older large breed animals [Togini et al. 2014, Carnier et al. 2004]. Other species of mammals are very rarely under investigation. ...
Morphological changes of the vertebrae, whether congenital or acquired, are more and more frequent causes of movement difficulties of both humans and other species of mammals. The most frequently diagnosed pathologies of the spine include: degenerative changes, congenital defects, inflammatory diseases, and proliferative changes. This article presents the characteristics of selected morphological changes in the spine, the reasons for their occurrence, and the diagnosis. Some of abnormalities have a genetic basis, sometimes already known, such as in the case of vertebral deformity syndrome in domestic cattle, which is caused by a mutation in the SLC35A3 gene. At other times, the genetic factor is only speculated as in the case of human scoliosis - some studies indicate its autosomal dominant nature of inheritance.
... [2][3][4] In the veterinary literature, only a small number of studies regarding the MRI features of specific polyostotic diseases have been published. [5][6][7][8][9] Little is known about the MRI features of multifocal vertebral lesions and how to differentiate aggressive from non-aggressive vertebral lesions. ...
Background:
There is a lack of information regarding magnetic resonance imaging (MRI) features of polyostotic vertebral lesions in dogs. The aim of this retrospective study was to identify and differenciate low-field MRI features of aggressive versus benign multifocal vertebral diseases in dogs.
Methods:
MRI examinations from 49 dogs with polyostotic vertebral lesions were reviewed. Images were evaluated for vertebral intensity changes, expansile lesions, new bone formation, cortical bone interruption, paravertebral musculature changes, lymphadenomegaly, spinal cord compression and spinal cord signal changes.
Results:
Twenty-nine dogs with non-aggressive bone lesions and 20 dogs with aggressive vertebral lesions were included. Non-aggressive lesions had variable T2-weighted fast spin-echo (T2W) signal intensity and the majority displayed low signal intensity on short tau inversion recovery (STIR). Aggressive lesions predominantly had high T2W and STIR signal intensity, with variable signal intensity on T1-weighted spin-echo and contrast enhancement. Aggressive lesions were associated with spinal pain (p < 0.01), new bone formation (p = 0.02), spinal cord compression (p < 0.01) and lymphadenomegaly (p < 0.01). Cortical interruption (p < 0.01) and paravertebral musculature changes (p < 0.01) were the strongest indicative imaging features for aggressive lesions.
Conclusion:
Spinal pain, spinal cord compression, new bone formation, lymphadenomegaly and especially cortical interruption and paravertebral musculature signal intensity changes were the best discriminators for differentiating malignant from benign vertebral lesions.
... Im MRT ist das Ausmass der Bandscheibendegeneration bei SD signifikant höher und die Signalintensität der knöchernen Zubildungen signifikant niedriger als bei DISH. Zudem werden Stenosen des Foramen intervertebrale und assoziierte neurologische Ausfällen bei DISH wesentlich seltener beobachtet als bei SD (Togni et al., 2014). ...
Diffuse idiopathic skeletal hyperostosis (DISH) is a common, non-inflammatory, systemic disease of the spine and the abaxial skeleton in humans and dogs. Spondylosis deformans (SD) must be considered as an important differential diagnosis which in humans, unlike DISH, is always accompanied by degenerative disc disease. In the veterinary literature, usually no difference is made between these diseases. The aim of the present review is to summarize essentials of DISH regarding its definition, etiology, prevalence, clinical findings and therapy in both, the human and dog. In particular, the various classification schemes and the most important differential diagnoses are discussed. Specific aspects of canine DISH are highlighted.
OBJECTIVE
To determine the occurrence of degenerative changes affecting the vertebral column in cats, assess their clinical significance, and determine the occurrence in cats with intervertebral disk herniation compared to other spinal diseases.
ANIMALS
114 client-owned cats.
METHODS
Hospital records were retrospectively reviewed for cats with suspected myelopathy that had undergone spinal MRI. Signalment; history; neurological examination; neurolocalization; primary diagnosis; presence, type, and location of intervertebral disk herniation; and presence and location of other degenerative spinal changes (intervertebral disk degeneration [IVDD], spondylosis deformans [SD], end plate changes, dorsal compressions [DC], and foraminal stenosis [FS]) were recorded.
RESULTS
70% of cats showed at least 1 spinal degenerative change. The most common change was IVDD, followed by SD and intervertebral disk protrusion (IVDP), while intervertebral disk extrusion (IVDE), end plate changes, DC, and FS were uncommon to rare. Primary complaint was attributed to a degenerative condition in 22% of cats, including 100% with IVDE, 9% with IVDP, and 43% with degenerative lumbosacral stenosis (DLSS). The occurrence of degenerative spinal changes and number of intervertebral disks affected by IVDD significantly increased with age and body weight. Age was positively correlated with the occurrence of SD and DLSS. Intervertebral disk degeneration, IVDP, SD, DC, and FS were more prevalent in the lumbosacral junction. Cats with IVDD were significantly more likely to show IVDE and IVDP.
CLINICAL RELEVANCE
This study revealed that in a population of cats presenting for signs of myelopathy, IVDE was always responsible for the clinical presentation, DLSS was commonly considered incidental, and IVDP was infrequently related to neurological signs.
Low back pain is a vital musculoskeletal disease that impairs life quality, leads to disability and imposes heavy economic burden on the society, while it is greatly attributed to intervertebral disc degeneration (IDD). However, the existing treatments, such as medicines, chiropractic adjustments and surgery, cannot achieve ideal disc regeneration. Therefore, advanced bioactive therapies are implemented, including stem cells delivery, bioreagents administration, and implantation of biomaterials etc. Among these researches, few reported unsatisfying regenerative outcomes. However, these advanced therapies have barely achieved successful clinical translation. The main reason for the inconsistency between satisfying preclinical results and poor clinical translation may largely rely on the animal models that cannot actually simulate the human disc degeneration. The inappropriate animal model also leads to difficulties in comparing the efficacies among biomaterials in different reaches. Therefore, animal models that better simulate the clinical charateristics of human IDD should be acknowledged. In addition, in vivo regenerative outcomes should be carefully evaluated to obtain robust results. Nevertheless, many researches neglect certain critical characteristics, such as adhesive properties for biomaterials blocking annulus fibrosus defects and hyperalgesia that is closely related to the clinical manifestations, e.g., low back pain. Herein, in this review, we summarized the animal models established for IDD, and highlighted the proper models and parameters that may result in acknowledged IDD models. Then, we discussed the existing biomaterials for disc regeneration and the characteristics that should be considered for regenerating different parts of discs. Finally, well-established assays and parameters for in vivo disc regeneration are explored.
A 9‐year‐old, male neutered Maine Coon was presented with a several month chronic and progressive weakness in the pelvic limbs, difficulties jumping and increasing aggressiveness towards members of the family. A proprioceptive pelvic limb ataxia, ambulatory paraparesis with postural deficits in both pelvic limbs and severe spinal hyperaesthesia were observed during the neurological examination. Radiographs and magnetic resonance imaging (MRI) of the spine were compatible with diffuse idiopathic skeletal hyperostosis (DISH), chronic spinal cord compression and foraminal stenosis. Mild improvement of the general discomfort without neurological amelioration was seen following 5 months of conservative management. To the authors’ knowledge, this is the first case report describing the radiographic and MRI characteristics of DISH in a feline patient.
A 32-yr-old male black-handed spider monkey (Ateles geoffroyi) with marked kyphosis and reduced spinal range of motion developed intermittent regurgitation, which was managed with an acid reducer. Diffuse idiopathic skeletal hyperostosis (DISH) was suspected in this animal due to radiographically evident ossification of the anterior longitudinal ligament. At repeat radiographic evaluation 1.5 yr later, due to weight loss and increased frequency of regurgitation, the cervical spine was deviated ventrally and appeared to be impinging on the thoracic inlet. The spider monkey was humanely euthanized due to poor prognosis, and the presumptive diagnosis of DISH was confirmed via postmortem computed tomography and necropsy. DISH has not been reported in black-handed spider monkeys, and secondary dysphagia, an uncommon but recognized consequence in humans, has not been reported in a nonhuman primate. Earlier recognition of this possibly underreported disease process may increase treatment options and effectiveness of intervention.
A 13-year-old, male, entire cocker spaniel was presented with a history of progressive discomfort during defecation. The referring veterinary surgeon suspected anal sacculitis and treated accordingly; however, this was unsuccessful, and the dog was referred for further investigations. Examination revealed marked resentment to manipulation of the tail but was otherwise unremarkable. Radiographs revealed lytic lesions in the first three caudal vertebrae, and MRI of the lumbosacral and first caudal nerves revealed severe enlargement of the caudal nerves within the vertebral canal with extension into the right ventral branches. These findings were highly suggestive of a nerve sheath tumour. Histological and immunohistochemical analysis of sampled tissues supported the suspected diagnosis. The dog was euthanised based on the guarded prognosis and perceived poor quality of life. This report describes an infrequent location for nerve sheath tumour with tail pain and discomfort during defecation as the only clinical manifestations.
Objective:
To report femoral neuropathy caused by nerve entrapment associated with diffuse idiopathic skeletal hyperostosis (DISH).
Study design:
Case report.
Animal:
Seven-year-old female spayed Boxer dog.
Results:
Entrapment of the right femoral nerve due to DISH caused a femoral nerve deficit and atrophy of muscle groups associated with the affected nerve. A combination of computed tomography and magnetic resonance imaging was performed to provide a diagnosis. Amputation of the right transverse process of the sixth lumbar vertebra at the level of nerve entrapment relieved the neurological abnormality.
Conclusions:
Nerve entrapment leading to neurapraxia may occur concurrently with DISH and surgery in this case was successful in restoring function.
Clinical relevance:
Peripheral neuropathy from nerve entrapment should be considered in patients with DISH. Surgical amputation of impinging osseous structures may be indicated for relief of femoral neuropathy.
To assess whether the Pfirrmann system for grading lumbar intervertebral disk (IVD) degeneration in humans can also be used in dogs.
202 dogs.
Magnetic resonance imaging was used to obtain images of vertebral segments from dogs, which were reviewed separately by 3 observers who graded the extent of degeneration in each visible IVD by use of the Pfirrmann classification system used for grading lumbar IVD degeneration in humans. Grading was validated against 2 factors associated with the extent of disk degeneration: type of dog (chondrodystrophic or nonchondrodystrophic breeds) and age.
Interobserver and intraobserver agreement for Pfirrmann grading of IVD degeneration were good (κ scores, 0.81 to 0.93). An increase in the extent of disk degeneration was positively correlated with increases in age and with chondrodystrophic breed.
The Pfirrmann system was reliably used to grade IVD degeneration in dogs of various breeds and ages. An increase in the extent of IVD degeneration was positively correlated with increases in age and with chondrodystrophic-type dogs.
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic disorder of the axial and peripheral skeleton in humans and has incidentally been described in dogs. The aims of this retrospective radiographic cohort study were to determine the prevalence of DISH in an outpatient population of skeletally mature dogs and to investigate if dogs can be used as an animal model for DISH. The overall prevalence of canine DISH was 3.8% (78/2041). The prevalence of DISH increased with age and was more frequent in male dogs, similar to findings in human studies. In the Boxer breed the prevalence of DISH was 40.6% (28/69). Dog breeds represent closed gene pools with a high degree of familiar relationship and the high prevalence in the Boxer may be indicative of a genetic origin of DISH. It is concluded that the Boxer breed may serve as an animal model for DISH in humans.
The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may render a new challenge for physicians treating spinal injuries.
A reliability study was conducted.
To develop a classification system for lumbar disc degeneration based on routine magnetic resonance imaging, to investigate the applicability of a simple algorithm, and to assess the reliability of this classification system.
A standardized nomenclature in the assessment of disc abnormalities is a prerequisite for a comparison of data from different investigations. The reliability of the assessment has a crucial influence on the validity of the data. Grading systems of disc degeneration based on state of the art magnetic resonance imaging and corresponding reproducibility studies currently are sparse.
A grading system for lumbar disc degeneration was developed on the basis of the literature. An algorithm to assess the grading was developed and optimized by reviewing lumbar magnetic resonance examinations. The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients (33 men and 27 women) with a mean age of 40 years (range, 10-83 years). All scans were analyzed independently by three observers. Intra- and interobserver reliabilities were assessed by calculating kappa statistics.
There were 14 Grade I, 82 Grade II, 72 Grade III, 68 Grade IV, and 64 Grade V discs. The kappa coefficients for intra- and interobserver agreement were substantial to excellent: intraobserver (kappa range, 0.84-0.90) and interobserver (kappa range, 0.69-0.81). Complete agreement was obtained, on the average, in 83.8% of all the discs. A difference of one grade occurred in 15.9% and a difference of two or more grades in 1.3% of all the cases.
Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation.
Degenerative disc disease (DDD) is a common finding in MRI scans and X-rays. However, their correlation to morphological and biochemical changes is not well established. In this study, radiological and MRI parameters of DDD were assessed and compared with morphological and biochemical findings of disc degeneration. Thirty-nine human lumbar discs (L1-S1), age 19-86 years, were harvested from eight cadavers. Within 48 h postmortem, MRIs in various spin-echo sequences and biplanar radiographs of intact spines were obtained. Individual discs with endplates were then sectioned in the mid-sagittal plane and graded according to the morphological appearance. Samples from the nucleus of each disc were harvested for biochemical analysis including water and proteoglycan contents. On MRIs, T2-signal intensity, Modic changes, disc extension beyond the interspace (DEBIT), nucleus pulposus shape, annular tears, osteophytes and endplate integrity were graded. On radiographs, an independent observer classified the parameters disc height, endplate sclerosis, osteophytes, Schmorl's nodes, intradiscal calcifications and endplate shape. General linear-regression models were used for statistical analysis. Backward elimination with a 10% significance cut-off level was used to identify the most significant parameters, which then were summed to create composite scores for radiography, MRI and the combination of both methods. The grading was performed by three observers, and a reliability analysis using Cronbach's alpha model was used to control interobserver agreement. The three radiographic parameters height-loss, osteophytes and intradiscal calcifications correlated significantly with the morphological degree of degeneration (p<0.001, R2=642). Significant differences of even one morphological grade could also be differentiated in the composite radiological score (p<0.05), except at the extremes between grades 1 and 2 and grades 4 and 5. All MRI parameters correlated significantly with the morphological grade (p<0.05); however Modic changes, T2-intensity and osteophytes accounted for 83% of the variation in the data. T2-signal intensity correlated significantly with H2O and proteoglycan content (p<0.001), and was best for detecting highly degenerated discs. Regression showed that the combined score was better correlated with the morphological grade (p<0.001, R2=775) than either the composite radiographic (p<0.001, R2=642) or composite MRI (p<0.001, R2=696) alone. Based on the combined score, a backwards elimination of the regression was performed, in which the parameters Modic changes, and T2-intensity loss (MRI) as well as calcifications (X-ray) accounted for 87% of the variability. The interobserver validation showed a high correlation for all three scores (Cronbach's alpha values ranging from 0.95 to 0.97). Conclusion: Selective imaging parameters and a newly created scoring scheme were found to correlate with disc degeneration as determined in a morphological manner. Surprisingly, radiographic parameters were able to distinguish different stages of degeneration, whereas MRI could only detect advanced stages of disc degeneration. We conclude that X-rays may remain a cost-effective, non-invasive in vivo-grading method to detect early disc degeneration, and, combined with MRI, correlate best with morphological and biochemical assessment of disc degeneration.
The aim of this study was to assess the prevalence of spondylosis deformans and to investigate genetic aspects of the degree of osteophytes development (DOD) in the Italian Boxer dog population. A total of 849 Boxer dogs was radiographed on the thoracic, lumbar, and sacral regions of the spine and scored for DOD. Grading of DOD was performed for all 20 intervertebral sites comprised within the first thoracic site (site T1-T2) and the site between the seventh lumbar and the first sacral vertebra (site L7-S1). Scores for DOD ranged from 0 (no osteophytes development) to 3 (presence of a bony spur formed by osteophytes on adjoining vertebrae). The first five thoracic sites exhibited no variation for DOD and were not considered in the analysis. The prevalence of spondylosis deformans was 84%, and frequency of dogs showing at least one intervertebral site that scored 3 for DOD was 50%. Scores for DOD at different sites were analyzed as different traits. Nongenetic effects influencing DOD scores were sex, age at screening, and the kennel. Posterior densities of heritability (h2) were estimated using a univariate Bayesian analysis. Eight sites exhibited a posterior probability greater than 0.8 for h2 > 10% and were considered in a multivariate restricted maximum likelihood analysis. Estimated h2 from multivariate analysis ranged from 25 to 48% (SE from 5 to 7%). Three sites exhibited h2 estimates greater than 40%. Genetic correlations for DOD scored at different sites ranged from 0.07 to 0.96. All thoracic sites had estimated correlations larger than 0.85 with other thoracic sites. Genetic correlation between the first and the second lumbar site was 0.91. Correlations between thoracic sites and the first two lumbar sites ranged from 0.5 to 0.9. Sites L6-L7 and L7-S1 also exhibited weak relationships with all remaining sites. Breeding values of dogs for DOD at the eight sites were predicted using estimated covariance matrices. A selection index for DOD was computed from predicted breeding values and a set of relative weighting factors produced by a panel of veterinarians. The index was the most important effect influencing phenotypic differences between dogs for average DOD score, number of affected sites, and number of sites with a DOD score > 1 (P < 0.001). The degree of osteophytes development is a trait showing exploitable additive genetic variance, and breeding programs for decreasing prevalence and severity of spondylosis deformans might focus on this trait.
To describe a case-series of patients who presented with the typical postural abnormalities of long-standing advanced ankylosing spondylitis (AS) but were instead found to suffer from diffuse idiopathic skeletal hyperostosis (DISH).
We enrolled consecutive patients who showed postural abnormalities, which at first suggested to us the diagnosis of long-standing advanced AS, although the diagnostic process led us to the correct diagnosis of DISH. Each patient had a complete physical examination and radiographs of the spine and pelvis, and was investigated for HLA-B27 locus typing.
From 15 June 1998 to 15 June 2006, 15 patients with DISH were seen who presented with the typical postural abnormalities of long-standing advanced AS. All patients were males with a median age of 69 yrs (range 51-91). All lacked HLA-B27 and denied personal or family history of spondyloarthritis. All measurements assessing cervical, thoracic and lumbar spinal movement were abnormal.
Patients suffering from DISH can occasionally have severe limitations of spinal mobility, along with postural abnormalities that resemble long-standing advanced AS. Thus, the differential diagnosis between DISH and advanced AS is not limited to the radiological findings and can also extend to the clinical findings in the two diseases, as is highlighted by our report.
(C) Williams & Wilkins 1997. All Rights Reserved.
Diffuse idiopathic skeletal hyperostosis (DISH) is common condition and its prevalence increases markedly with age. This paper describes the pathology and aetiology of the condition; DISH seems to be related to obesity and type II diabetes and is probably a multisystem hormonal disorder. DISH occurs frequently in human skeletal remains, particularly in those recovered from monastic sites.
Evidence is presented to confirm this association and the causes are discussed. We also present criteria for the diagnosis of DISH in human remains, which we suggest would permit valid inter-study comparisons. Copyright
Spondylosis deformans is a generalised disease of ageing resulting in formation of bony osteophytes around degenerating intervertebral discs throughout the vertebral column. It is noninflammatory and needs to be differentiated from spondylitis, which is either an infectious or noninfectious inflammatory process. Lateral radiographs of 310 female beagle dogs from a closed colony showed development of spondylosis deformans that was age-dependent and located principally at discs numbers 5, 15, and 20 to 23. It was noteworthy that disc 26 was minimally involved whereas this location has been previously reported to have frequent involvement in larger breeds of dogs. None of the dogs studied had clinical signs causing their removal from the colony, further supporting the concept that spondylosis deformans as a bony response to disc degeneration is not a cause of severe pain or lameness.
Spondylosis deformans (vertebral osteophytosis) in the dog was studied radiographically in material from Bristol (England), Stockholm (Sweden), and Fort Collins (Colorado, U.S.A.). The incidence was dependent on age, sex, and breed with the lesion more common in older age, females and boxers. The pattern of distribution of the osteophytes was similar in all groups. The average size of the osteophytes was not dependent on its location but was similar throughout the vertebral column. The condition was present as often in dogs with clinical signs related to the spine as in those without.
Résumé— —La spondylose deformans (ostéophytose vertebrale) chez le chien a étéétudiée radio‐graphiquement avec un materiel de Bristol (Angleterre), Stockholm (Suéde) et Fort Collins (U.S.A.). L'incidence est indépendante de P'áge, du sexe et de la race avec des lésions plus communes chez les chiens d'âge avancé, les femelles et les boxers. Le motif de distribution des ostéophytes est similaire dans tous les groupes. La taille moyenne des ostéophytes ne dépend pas de son emplacement mais est similaire le long de la colonne vertebrale. La condition a été constatée aussi souvent chez les chiens ayant des signes cliniques reliés à l'épine dorsale que chez ceux n'en ayant pas.
Zusammenfassung— —Material aus Bristol (England), Stockholm (Schweden), und Fort Collins (Colorado, U.S.A.) betreffend spondylosis deformans (vertebraler Knochenauswuchs) bei Hunden wurde radiographisch untersucht. Die auftretenden Fälle hingen vom Alter, dem Geschlecht und der Rasse ab, wobei Verletzungen bei älteren Tieren, Weibchen und Boxern häufiger vorkamen. Bei alien Gruppen war das Verteilungsbild der Knochenauswüchse ähnlich. Die Durchschnittsgrösse der Knochenauswüchse hing nicht von ihrer örtlichen Lage ab, sondern war gleichartig entlang der gesamten Wirbelsäule. Dieser Zustand zeigte sich ebenso oft bei Hunden mit klinischen Anzeichen in Verbindung mit dem Rückgrat wie bei solchen ohne derartige Erscheinungen.
Spinal and extraspinal manifestations similar to Forestier's disease, or disseminated idiopathic skeletal hyperostosis (DISH), are described in a 4-year-old female Great Dane dog. Radiographic features included linear new bone formation with a smooth wavy contour along the ventral and lateral aspects of vertebral bodies plus hyperostosis at ligamentous attachments in the spine (enthesiophytes) causing bony ankylosis. Periarticular new bone and enthesiopathy were present in extraspinal locations. Clinical signs possibly relate to limitations in motion because of the vertebral fusion and extraspinal arthrosis.
Spondylosis deformans and diffuse idiopathic skeletal hyperostosis (DISH) are usually incidental findings and in most dogs are either asymptomatic or associated with mild clinical signs. Severe spondylosis deformans and DISH can result in complete bony fusion of consecutive vertebral segments. One of the recognised complications following vertebral fusion in human patients is the development of adjacent segment disease, which is defined as degenerative changes, most commonly degenerative intervertebral disc disease, in the mobile vertebral segment neighboring a region of complete vertebral fusion. A similar syndrome following cervical fusion in dogs has been termed the domino effect. The purpose of this retrospective study was to investigate the hypothesis that vertebral fusion occurring secondary to spondylosis deformans or DISH in dogs would protect fused intervertebral disc spaces from undergoing degeneration, but result in adjacent segment disease at neighbouring unfused intervertebral disc spaces. Eight dogs with clinical signs of thoracolumbar myelopathy, magnetic resonance imaging of the thoracolumbar vertebral column, and spondylosis deformans or DISH producing fusion of > or = 2 consecutive intervertebral disc spaces were evaluated. Vertebral fusion of > or = 2 consecutive intervertebral disc spaces was correlated (P = 0.0017) with adjacent segment disease at the neighbouring unfused intervertebral disc space. Vertebral fusion appeared to protect fused intervertebral disc spaces from undergoing degeneration (P < 0.0001). Adjacent segment disease should be considered in dogs with severe spondylosis deformans or DISH occurring in conjunction with a thoracolumbar myelopathy.
The model selection literature has been generally poor at reflecting the deep foundations of the Akaike information criterion (AIC) and at making appropriate comparisons to the Bayesian information criterion (BIC). There is a clear philosophy, a sound criterion based in information theory, and a rigorous statistical foundation for AIC. AIC can be justified as Bayesian using a “savvy” prior on models that is a function of sample size and the number of model parameters. Furthermore, BIC can be derived as a non-Bayesian result. Therefore, arguments about using AIC versus BIC for model selection cannot be from a Bayes versus frequentist perspective. The philosophical context of what is assumed about reality, approximating models, and the intent of model-based inference should determine whether AIC or BIC is used. Various facets of such multimodel inference are presented here, particularly methods of model averaging.
Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed condition relating to ossification of spinal ligaments that can cause compression of the esophagus and trachea. According to case reports, dysphagia or airway obstruction resulting from DISH is a rare occurrence.
This study was intended to identify all published cases of dysphagia and/or airway obstruction resulting from DISH to increase the epidemiologic/clinical knowledge of these related conditions.
A systematic review of the literature was performed.
The articles resulting from the systematic PubMed/EMBASE search of the literature were closely read, and predefined parameters were scored.
The search yielded a total of 118 articles (95 case reports and 23 case series) describing 204 patients with dysphagia and/or airway obstruction resulting from DISH. The number of cases demonstrated a steady increase from 1980 to 2009. This might be a real effect not ascribable to publication bias or expansion of the medical literature alone.
Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia and/or airway obstruction may be an increasing and underappreciated phenomenon. Diffuse idiopathic skeletal hyperostosis should be included in the differential diagnosis of dysphagia and airway obstruction.
The vertebral involvement of DISH is described from an evaluation of 215 cadaveric spines and 100 patients with the disease. Radiographic features include linear new bone formation along the anterolateral aspect of the thoracic spine, a bumpy contour, subjacent radiolucency, and irregular and pointed bony excrescences at the superior and inferior vertebral margins in the cervical and lumbar regions. Pathologic features include focal and diffuse calcification and ossification in the anterior longitudinal ligament, paraspinal connective tissue, and annulus fibrosis, degeneration in the peripheral annulus fibrosis fibers, L-T-, and Y-shaped anterolateral extensions of fibrous tissue, hypervascularity, chronic inflammatory cellular infiltration, and periosteal new bone formation on the anterior surface of the vertebral bodies.
The radiographic and necropsy findings in a case of canine diffuse idiopathic skeletal hyperostosis are reported. Radiographically, the disease was characterized by progressive development of para-articular mineral densities along joint surfaces of the appendicular skeleton; progressive osseous fusion of the ilium, pubis, femur, and ischium; and progressive flowing ossification of the dorsal spinous processes of cervical and thoracic vertebrae. The para-articular lesions were considered to develop as a consequence of fibrocartilaginous proliferation followed by endochondral ossification. Progression of the ossification process led to para-articular joint fusion and almost complete ossification of the metaplastic cartilage. A distinguishing feature was the sparing of intra-articular structures.
This study presents the estimates of heritability for spondylosis deformans in the boxer based on 353 offspring from 24 randomly selected sires, each with at least three radiographically investigated offspring. The estimated heritability (h2) for maximum degree of osteophyte development was high, both when estimated by paternal half-sib correlation (0.42) and by the regression of offspring based on the parents (0.62). The heritability for the number of affected discs estimated by paternal half-sib correlation was also high (0.47). The estimate of heritability for the number of affected discs based on regression of offspring on the parents was lower at 0.13. All heritabilities had large standard errors. A positive phenotypic correlation between spondylosis deformans and hip dysplasia was observed. Assuming a significant portion of the correlation is genetic, this fact may permit selection against spondylosis deformans without negatively influencing the incidence of hip dysplasia. Since the incidence of spondylosis deformans is high even in young dogs, it should be possible to detect a large proportion of genetically predisposed animals by radiographic examination of the spine at one year of age; at the same time that dogs are presented for a routine test for hip dysplasia.
For in vitro studies, there is no basis for choosing a "load control study" over a "displacement control" study. This study qualitatively compared results from in vitro and in vivo tests, allowing the authors to address the experimental assumptions that in vitro testing contributes to the understanding of the in vivo condition.
To compare motion changes at segments adjacent to fusions for in vitro and in vivo tests.
Investigators have measured the effects of spinal fusions on the adjacent segment in a human cadaver model and found greater adjacent facet joint load after fusions. Others have found significant increases in motion and facet loads at segments adjacent to in vitro lumbosacral and long fusions, when the same range of motion was repeated before and after immobilization of lumbar segments.
L2-L3 motion was measured in vitro by an instrumented spatial linkage under load and displacement control before and after immobilization of segments (L3-L7). In vivo, L2-L3 motion was measured while animals walked on a treadmill. L3-L7 was fused and the L2-L3 motion testing was repeated. The change in in vivo adjacent segment motion was qualitatively compared with the in vitro change under "load" and "displacement" control.
Under "load" control, in vitro facet motion did not significantly change after immobilization, whereas under "displacement" control, the facet motion significantly increased from 2.2 +/- 0.4 mm to 4.1 +/- 0.6 mm. Post-instrumentation, in vivo L2-L3 facet motion increased significantly. This change in vivo related better to the changes seen in the in vitro "displacement" control test than to the in vitro "load" control test.
The infra-aortic spinal arteries caudal to the aortic bifurcation were studied in 20 perinatal and adult cadavers to determine their import relative to extraforaminal approaches to the lower lumbar discs as well as their probable involvement in certain cases of radiculomedullary ischemia. Analysis of these specimens indicated that, despite considerable variation, the arteries to the L4-L5 and L5-S1 intervertebral foramens generally were not related to the disc dorsolateral zones where lateral surgical approaches are best accomplished. Also, the frequency in which the fourth as well as the fifth lumbar and all sacral segmental vessels were dependent on the posterior division of the hypogastric artery may help explain how spinal cord ischemia could occur in individuals with vulnerable cord vascular patterns and/or spinal arteriopathy after interruption of hypogastric artery blood flow during pelvic operations.
Diffuse idiopathic skeletal hyperostosis (DISH) is a common but little-studied disorder in the elderly that is infrequently recognized by physicians. Its prevalence in adults over 40 years of age is estimated at 3.8% for men and 2.6% for women. The present case-control study evaluated the history of pain and stiffness, radicular pain and enthesitis, physical findings on the musculoskeletal examination, and level of physical and psychologic disability in 130 persons: 56 patients with DISH, 43 control patients with spondylosis of the lumbar spine, and 31 healthy control patients. DISH patients were more likely to report a past history of upper extremity pain, medial epicondylitis of the elbow, enthesitis of the patella or heel, or dysphagia than spondylosis patients. They had more extremity and spinal stiffness and pain than healthy controls. DISH patients weighed more at a young age and their body mass index was greater at the time of the clinical evaluation than either spondylosis or healthy control patients. On musculoskeletal examination, DISH patients had a greater reduction in neck rotation and thoracic movements than either spondylosis patients or healthy controls, and had a greater reduction in lumbar movement than healthy controls. DISH patients had similar levels of spinal disability and physical disability overall, as measured by standardized indices, as spondylosis patients. No differences were found among the 3 groups of patients for the laboratory tests evaluated. DISH is clearly a distinct disorder with signs and symptoms that distinguish it from other causes of spinal complaint and from healthy individuals. It has the potential to cause major disability. Future studies need to address the natural history of DISH, pursue pathogenic mechanisms, and evaluate treatment modalities.
To describe the axial and appendicular skeleton findings of diffuse idiopathic skeletal hyperostosis. To analyze the role of conventional radiography, computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of this condition. To discuss the differential diagnosis and diagnostic pitfalls of this disease.
The involvement of vertebral and extravertebral sites including the pelvis, calcaneum, ulnar olecranon, and patella is frequently found in the literature. The lesions described are the anterior and lateral ossification of the spine, hyperostosis at sites of tendon and ligament insertion, ligamentous ossification, and periarticular osteophytes. The criteria for the diagnosis of diffuse idiopathic skeletal hyperostosis involving the spine are: flowing ossification along the anterior and anterolateral aspects of at least four contiguous vertebrae, preserved intervertebral disc height, no bony ankylosis of the posterior spinal facet joints, and finally no erosion, sclerosis or bony ankylosis of the sacroiliac joints.
The disease has about the same frequency in men (65%) and women (35%); it is most common in the thoracic spine and occurs less frequently in the lumbar and cervical spine. The disease most commonly presents in the sixth and seventh decades of life and its estimated frequency in the elderly is 5-15%. Signs and symptoms include stiffness and pain in the back, dysphagia due to direct esophageal compression/distorsion, pain related to associated tendinitis, myelopathy related to core compression associated to the ossification of the posterior longitudinal ligament, and pain related to vertebral complications--e.g. fracture/subluxation.
While conventional radiography clearly confirms the diagnosis of diffuse idiopathic skeletal hyperostosis, CT and MRI better detect associated findings (e.g. ossification of the posterior longitudinal ligament) and complications (e.g. spinal cord compressive myelomalacia).
Lumbar fusion is commonly performed to relieve pain from degenerative conditions, including spinal stenosis and spondylolisthesis. While clinical studies have reported favorable fusion rates with limited complications, few have investigated the effect of fusion on the adjacent motion segment. A solid fusion alters the biomechanics at the adjacent level, resulting in increased mechanical demands. There have been reports of increased rates of adjacent-level pathologic lesions after fusion, but these have not accounted for the natural history of degenerative changes. Biomechanical and radiographic studies have shown increased forces, mobility, and intradiscal pressure in adjacent segments after fusion. It has been hypothesized that these changes lead to an acceleration in pathologic changes.
Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder of unknown etiology that is characterized by back pain and spinal stiffness. There may be mild pain if ankylosis has occurred. The condition is recognized radiographically by the presence of "flowing" ossification along the anterolateral margins of at least four contiguous vertebrae and the absence of changes of spondyloarthropathy or degenerative spondylosis. Even in patients who present with either lumbar or cervical complaints, radiographic findings are almost universally seen on the right side of the thoracic spine. Thus, radiographic examination of this area is critical when attempting to establish a diagnosis of DISH. The potential sequelae of hyperostosis in the cervical and lumbar spine include lumbar stenosis, dysphagia, cervical myelopathy, and dense spinal cord injury resulting from even minor trauma. There may be a delay in diagnosis of spinal fractures in a patient with DISH because the patient often has a baseline level of spinal pain and because the injury may be relatively trivial. The incidence of delayed neurologic injury due to such fractures is high as a result of unrecognized instability and subsequent deterioration. Extraspinal manifestations are also numerous and include an increased risk of heterotopic ossification after total hip arthroplasty. Prophylaxis to prevent heterotopic ossification may be indicated for these patients.
Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disease characterized by ligamentous ossification of the anterolateral side of the spine. The aim of this study was to characterize risk factors associated with DISH.
Subjects were recruited for participation in a screening survey of vertebral osteoporosis. The cases were 69 men and 62 women with DISH and the controls were 69 men and 62 women with spondylosis over the age of 50 yr. Cases and controls were matched for age and sex. Radiographs were taken according to a standardized protocol and DISH was classified using the Resnick criteria. Laboratory parameters and an interviewer-administered questionnaire were used to obtain data about exposure.
The mean ages of the populations with DISH and spondylosis were 65.2+/-8.8 and 65.0+/-9.1 yr respectively. Compared with controls, patients with DISH had a greater body mass index (27.8 vs 26.0 kg/m(2), P<0.05) and a higher serum level of uric acid (308 vs 288 micromol/l, P<0.05) and were more likely to have had diabetes mellitus (19.8 vs 9.1%, P<0.05).
DISH is clearly a distinct disorder with risk factors that distinguish it from other spinal degenerative diseases.
Review of the literature.
Review the definition, etiology, incidence, and risk factors associated with as well as potential treatment options.
The development of pathology at the mobile segment next to a lumbar or lumbosacral spinal fusion has been termed adjacent segment disease. Initially reported to occur rarely, it is now considered a potential late complication of spinal fusion that can necessitate further surgical intervention and adversely affect outcomes.
MEDLINE literature search.
The most common abnormal finding at the adjacent segment is disc degeneration. Biomechanical changes consisting of increased intradiscal pressure, increased facet loading, and increased mobility occur after fusion and have been implicated in causing adjacent segment disease. Progressive spinal degeneration with age is also thought to be a major contributor. From a radiographic standpoint, reported incidence during average postoperative follow-up observation ranging from 36 to 369 months varies substantially from 5.2 to 100%. Incidence of symptomatic adjacent segment disease is lower, however, ranging from 5.2 to 18.5% during 44.8 to 164 months of follow-up observation. The rate of symptomatic adjacent segment disease is higher in patients with transpedicular instrumentation (12.2-18.5%) compared with patients fused with other forms of instrumentation or with no instrumentation (5.2-5.6%). Potential risk factors include instrumentation, fusion length, sagittal malalignment, facet injury, age, and pre-existing degenerative changes.
Biomechanical alterations likely play a primary role in causing adjacent segment disease. Radiographically apparent, asymptomatic adjacent segment disease is common but does not correlate with functional outcomes. Potentially modifiable risk factors for the development of adjacent segment disease include fusion without instrumentation, protecting the facet joint of the adjacent segment during placement of pedicle screws,fusion length, and sagittal balance. Surgical management, when indicated, consists of decompression of neural elements and extension of fusion. Outcomes after surgery, however, are modest.
To evaluate the association between spondylosis deformans and clinical signs of intervertebral disk disease (IVDD) in dogs.
Retrospective case series.
210 dogs.
Records of 172 dogs with clinical signs of IVDD and 38 dogs with other neurologic disorders were reviewed. Signalment, sites of spondylosis, severity of associated osteophytosis, type of disk herniation, and duration of signs were recorded.
Dogs with IVDD had significantly fewer sites of involvement and lower grades of spondylosis deformans, compared with those in the non-IVDD group. When groups were adjusted for age and weight via multivariate linear regression, there were no differences in severity of osteophytosis or number of affected sites. Dogs with type II disk disease had higher numbers of affected sites and more severe changes, compared with dogs with type I disk herniation. There was no difference between groups in the rate at which IVDD was diagnosed at sites of spondylosis, compared with the rate at which IVDD was diagnosed in unaffected disk spaces. Areas of spondylosis were closer to sites of IVDD that elicited clinical signs than to randomly chosen intervertebral spaces, and distances between sites of spondylosis and sites of IVDD had a bimodal appearance.
An association may exist between radiographically apparent spondylosis and type II disk disease; type I disk disease was not associated with spondylosis. Spondylosis in radiographs of dogs with suspected type I disk disease is not clinically important. Spatial associations among sites of spondylosis and sites of IVDD may be coincidental or associated with vertebral column biomechanics.
The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years. Disk degeneration involves structural disruption and cell-mediated changes in composition. Mechanical, traumatic, nutritional, and genetic factors all may play a role in the cascade of disk degeneration, albeit to variable degree in different individuals. The presence of degenerative change is by no means an indicator of symptoms, and there is a very high prevalence in asymptomatic individuals. The etiology of pain as the symptom of degenerative disease is complex and appears to be a combination of mechanical deformation and the presence of inflammatory mediators. The role of imaging is to provide accurate morphologic information and influence therapeutic decision making. A necessary component, which connects these two purposes, is accurate natural history data. Understanding the relationship of etiologic factors, the morphologic alterations, which can be characterized with imaging, and the mechanisms of pain production and their interactions in the production of symptoms will require more accurate and reproducible stratification of patient cohorts.
Diffuse idiopathic skeletal hyper-ostosis Prevalence of spondylosis deformans and estimates of genetic parameters for the degree of osteophytes development in italian boxer dogs
- M Cammisa
- De Serio
- A Guglielmi
- G Carnier
Cammisa, M., De Serio, A. & Guglielmi, G., 1998. Diffuse idiopathic skeletal hyper-ostosis. European Journal of Radiology 27, S7-S11 Carnier, P., et al. 2004. Prevalence of spondylosis deformans and estimates of genetic parameters for the degree of osteophytes development in italian boxer dogs. Journal of Animal Science 82, 85-92
Untersuchungen zur Spondylosis deformans bei Boxern
- Eichelberg H.
Eichelberg, H. & Wurster, H., 1982. Untersuchungen zur Spondylosis deformans
bei Boxern. Kleintierpraxis 27, 393-396
Spondylosis deformans Textbook of Small Animal Orthopaedics 61, 733–738 DISH and spondylosis deformans Verlaan, Diffuse idiopathic skeletal hyperostosis of the cervi-cal spine: an underestimated cause of dysphagia and airway obstruction
- J P Morgan
- D N Biery
- C D J J Newton
Morgan, J. P., Biery, D. N. & Newton, C. D., 1985. Spondylosis deformans Textbook of Small Animal Orthopaedics 61, 733–738 DISH and spondylosis deformans Verlaan, J. J., et al. 2011. Diffuse idiopathic skeletal hyperostosis of the cervi-cal spine: an underestimated cause of dysphagia and airway obstruction. The Spine Journal 11, 1058-1067
Spondylosis deformans Textbook of Small Animal Orthopaedics 61 Diffuse idiopathic skeletal hyperostosis of the cervical spine: an underestimated cause of dysphagia and airway obstruction
- J P Morgan
- D N Biery
- C D Newton
- J J Deformans Verlaan
Morgan, J. P., Biery, D. N. & Newton, C. D., 1985. Spondylosis deformans Textbook
of Small Animal Orthopaedics 61, 733–738
DISH and spondylosis deformans
Verlaan, J. J., et al. 2011. Diffuse idiopathic skeletal hyperostosis of the cervical spine: an underestimated cause of dysphagia and airway obstruction. The
Spine Journal 11, 1058-1067
Spondylosis deformans Textbook of
- J P Morgan
- D N Biery
- C D Newton
Morgan, J. P., Biery, D. N. & Newton, C. D., 1985. Spondylosis deformans Textbook
of Small Animal Orthopaedics 61, 733-738
Studium der Veterinärmedizin an der Universität Zürich 3
Studium der Veterinärmedizin an der Universität Zürich
3. Nov. 2006
Abschlussprüfung vet. med., Universität Zürich, Schweiz
SUPPORTING INFORMATION The following supporting information is available for this article: Fig S1. Transverse T2-weighted MRI of case 1, showing foraminal stenosis L6-7 due to DISH bone on the left side (black arrow)
- J C Woodard
Woodard, J. C., et al. 1985. Canine diffuse idiopathic skeletal hyperostosis.
Veterinary Pathology 22, 317-326
SUPPORTING INFORMATION
The following supporting information is available for this article:
Fig S1. Transverse T2-weighted MRI of case 1, showing foraminal stenosis L6-7 due to DISH bone on the left side (black
arrow). The white arrow is showing a healthy nucleus pulposus