Giammalva Giuseppe R, Maugeri Rosario, Cusimano Luigi M, Sciortino Andrea S, Bonosi Lapo, Brunasso Lara, Costanzo Roberta, Signorelli Francesco, Tumbiolo Silvana, Iacopino Domenico G, Visocchi Massimiliano
Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy.
Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
J Craniovertebr Junction Spine. 2023 Jul-Sep;14(3):274-280. doi: 10.4103/jcvjs.jcvjs_72_23. Epub 2023 Sep 18.
Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's syndrome may reduce vertebral mobility, thus affecting the stability of adjacent vertebral segments and promoting spinal stenosis, vertebral dislocation, and unstable fracture secondary to low-energy trauma.
This study aimed to contribute with a case series of three patients affected by DISH undergone surgery with occipitocervical fixation for craniovertebral junction (CVJ) instability since the poor literature about CVJ instability and surgery in patients affected by DISH.
This was a multicentric case series.
Literature about CVJ instability and surgery in patients affected by DISH is poor. Thus, we present a case series of three patients affected by DISH, who underwent surgery with occipitocervical fixation with different clinical and radiological patterns.
CVJ represents one of the most mobile joints of the spine and is at greater risk for instability. Moreover, instability itself may act as for several degenerative conditions such as cervical spondylosis, ossification of the posterior longitudinal ligament, and cervical deformities. On the contrary, DISH itself may worsen CVJ instability because of subaxial spine stiffness. In case of DISH, the rigid unit formed by several ossified vertebral bodies acts as a long lever arm, increasing the forces applied to the hypermobile CVJ and reducing the dynamic buffer capability of ossified spine. On the other hand, vertebral instability increases the odds of fractures. In such cases, CVJ posterior instrumentation and fusion is an effective and feasible surgical technique, aimed to restore vertebral stability and to halt the progression of spinal stenosis.
Due to the altered dynamics cervical spine along with the possible comorbidities, treatment indication and surgery for patients affected by DISH must be tailored case by case.
弥漫性特发性骨肥厚（DISH）或福里斯特尔综合征可能会降低椎体活动度，从而影响相邻椎体节段的稳定性，并促使椎管狭窄、椎体脱位以及继发于低能量创伤的不稳定骨折。
由于关于DISH患者颈椎关节（CVJ）不稳定及手术的文献较少，本研究旨在通过一个包含三例DISH患者的病例系列，这些患者因CVJ不稳定接受了枕颈固定手术。
这是一个多中心病例系列。
关于DISH患者CVJ不稳定及手术的文献较少。因此，我们呈现一个包含三例DISH患者的病例系列，他们因不同的临床和放射学表现接受了枕颈固定手术。
CVJ是脊柱中活动度最大的关节之一，发生不稳定的风险更高。此外，不稳定本身可能是导致多种退行性疾病的原因，如颈椎病、后纵韧带骨化和颈椎畸形。相反，由于下颈椎僵硬，DISH本身可能会加重CVJ不稳定。在DISH病例中，由多个骨化椎体形成的刚性单元充当一个长杠杆臂，增加了施加于活动过度的CVJ的力，并降低了骨化脊柱的动态缓冲能力。另一方面，椎体不稳定会增加骨折几率。在这种情况下，CVJ后路内固定和融合是一种有效且可行的手术技术，旨在恢复椎体稳定性并阻止椎管狭窄的进展。
由于颈椎动力学改变以及可能存在的合并症，DISH患者的治疗指征和手术必须根据具体情况量身定制。
