Fournier Dale E, Kiser Patti K, Beach Ryan J, Dixon S Jeffrey, Séguin Cheryle A
1Health and Rehabilitation Sciences (Physical Therapy), Faculty of Health Sciences, The University of Western Ontario, London, ON N6A 5B9 Canada.
2Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4 Canada.
Bone Res. 2020 Apr 2;8:16. doi: 10.1038/s41413-020-0091-6. eCollection 2020.
Diffuse idiopathic skeletal hyperostosis (DISH) is a prevalent noninflammatory spondyloarthropathy characterized by ectopic mineral formation along the anterolateral aspect of the vertebral column, yet little is known about its underlying pathogenesis. Our objective was to evaluate the histopathological features and composition of ectopic mineral within spinal tissues affected by DISH in humans. Thoracic spine segments from six embalmed cadaveric donors (one female and five males; median age 82 years) meeting the radiographic diagnostic criteria for DISH were evaluated using radiological, histological, and physical analyses. Overall, the histological features of ectopic mineralization at individual motion segments were heterogeneous, including regions of heterotopic ossification and dystrophic calcification. Heterotopic ossifications were characterized by woven and lamellar bone, multifocal areas of metaplastic cartilage, and bony bridges along the anterior aspect of the intervertebral disc space. Dystrophic calcifications were characterized by an amorphous appearance, a high content of calcium and phosphorus, an X-ray diffraction pattern matching that of hydroxyapatite, and radiodensities exceeding that of cortical bone. Dystrophic calcifications were found within the anterior longitudinal ligament and annulus fibrosus in motion segments both meeting and not meeting the radiographic criteria for DISH. In summary, our findings indicate that in DISH, ectopic mineral forms along the anterior aspect of the spine by both heterotopic ossification and dystrophic calcification of fibrocartilaginous tissues. Although both types of ectopic mineralization are captured by current radiographic criteria for DISH, dystrophic calcification may reflect a distinct disease process or an early stage in the pathogenesis of DISH.
弥漫性特发性骨肥厚（DISH）是一种常见的非炎性脊柱关节病，其特征是沿脊柱前外侧异位矿物质形成，但其潜在发病机制尚不清楚。我们的目的是评估人类DISH受累脊柱组织中异位矿物质的组织病理学特征和成分。使用放射学、组织学和物理分析方法，对来自六名符合DISH影像学诊断标准的防腐尸体供体（一名女性和五名男性；中位年龄82岁）的胸椎节段进行了评估。总体而言，各个运动节段异位矿化的组织学特征各不相同，包括异位骨化和营养不良性钙化区域。异位骨化的特征是编织骨和板层骨、多灶性化生软骨区域以及椎间盘间隙前方的骨桥。营养不良性钙化的特征是无定形外观、高钙磷含量、与羟基磷灰石匹配的X射线衍射图谱以及高于皮质骨的放射密度。在符合和不符合DISH影像学标准的运动节段的前纵韧带和纤维环中均发现了营养不良性钙化。总之，我们的研究结果表明，在DISH中，异位矿物质通过纤维软骨组织的异位骨化和营养不良性钙化沿脊柱前方形成。虽然这两种类型的异位矿化都被目前DISH的影像学标准所捕捉，但营养不良性钙化可能反映了一种独特的疾病过程或DISH发病机制的早期阶段。
