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老年弥漫性特发性骨肥厚（DISH）患者的颈椎脊髓病和腰椎滑脱——病例系列

Cervical Myelopathy and Lumbar Spondylolisthesis in Elderly Patients with Diffuse Idiopathic Skeletal Hyperostosis (DISH) - A Case Series.

作者信息

Mahajan Neetin P, S Prasanna Kumar G, Chandanwale Ajay S, Sonawane Dhiraj V, Patil Om Parshuram, Yadav Amit Kumar

机构信息

Department of Orthopaedics, Grant Government Medical College and sir JJ group of hospitals, Mumbai, Maharashtra, India.

DMER, Mumbai, Maharashtra, India.

出版信息

J Orthop Case Rep. 2020 Nov;10(8):48-52. doi: 10.13107/jocr.2020.v10.i08.1856.

DOI:10.13107/jocr.2020.v10.i08.1856
PMID:33708711
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7933642/
Abstract

INTRODUCTION

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease, which causes the ossification of spinal longitudinal ligaments and enthesis leads to stiffness in the affected segment of the spine and neurological deficit due to compression of spinal cord or nerve roots by osteophytes.

CASE PRESENTATION

We present three cases of DISH, presented with cervical myelopathy, lumbar spondylolisthesis, and dysphagia. All three patients had neurodeficit and radiological examination showed cord compression, canal stenosis, listhesis, and contiguous ossification in the spine with normal sacroiliac joints. The first patient had cervical myelopathy because of compression of cord by ossified posterior longitudinal ligament, which was managed with posterior laminectomy, decompression, and stabilization. The second patient had L4-L5 listhesis with canal stenosis, which was managed with decompression, instrumentation and fusion (TLIF). The third patient had cervical myelopathy due to C6-C7 listhesis and also had dysphagia because of compression of esophagus by anterior osteophytes, which was managed with removal of anterior osteophytes and anterior discectomy and fusion (ACDF). Postoperatively, all three patients recovered completely with no residual neurodeficit.

CONCLUSION

DISH can present in various ways, which depends on the site of involvement in the spine. Early surgical intervention helps in getting a better outcome in patients with neurodeficit and prevents further complications.

摘要

引言

弥漫性特发性骨肥厚（DISH）是一种非炎性疾病，可导致脊柱纵韧带骨化和附着点骨化，进而引起脊柱受累节段僵硬，并因骨赘压迫脊髓或神经根导致神经功能缺损。

病例报告

我们报告3例DISH患者，分别表现为颈髓病、腰椎滑脱和吞咽困难。所有3例患者均有神经功能缺损，影像学检查显示脊髓受压、椎管狭窄、椎体滑脱以及脊柱连续骨化，而骶髂关节正常。第1例患者因后纵韧带骨化压迫脊髓导致颈髓病，接受了后路椎板切除术、减压和内固定治疗。第2例患者有L4-L5椎体滑脱伴椎管狭窄，接受了减压、器械辅助和融合（经椎间孔腰椎椎体间融合术）治疗。第3例患者因C6-C7椎体滑脱导致颈髓病，同时因前方骨赘压迫食管出现吞咽困难，接受了前方骨赘切除、前路椎间盘切除和融合（前路颈椎间盘切除融合术）治疗。术后，所有3例患者均完全康复，无残留神经功能缺损。

结论

DISH可表现为多种形式，这取决于脊柱受累部位。早期手术干预有助于神经功能缺损患者获得更好的预后，并预防进一步并发症。

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