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1/12. Dysphagia in a patient with giant osteophytes: case presentation and review of the literature.

    A patient with increasing dysphagia due to external bone compression of the oesophagus is presented. Radiographic evaluation revealed the underlying condition to be a diffuse idiopathic skeletal hyperostosis with exuberant and bumpy change within the anterior longitudinal ligament.
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2/12. Diffuse idiopathic skeletal hyperostosis in a patient with idiopathic retroperitoneal fibrosis: a case report.

    Idiopathic retroperitoneal fibrosis (IRF) is a rare rheumatologic disease with obscure pathogenesis. Its manifestations depend upon the structures involved. Diffuse idiopathic skeletal hyperostosis (DISH) is usually seen in male patients over 45 years of age and characterized by new bone formation at the entheses. The dorsal spine is most commonly involved, but radiographic findings in both the spine and extraspinal structures suggest a generalized disorder of ossification rather than a localized spinal disease. The association of IRF and DISH has not been reported before. There is proliferation of connective tissue in both of these diseases, and they may share a common etiopathogenetic basis. We describe a patient having features of both IRF and DISH.
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3/12. Spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis: a case report.

    STUDY DESIGN: We report on a 69-year-old male who had severe back pain due to spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis. OBJECTIVE: To describe a rare clinical entity and successful treatment by spinal fusion with a 4-year follow-up. SUMMARY OF BACKGROUND DATA: There have been a few reports of spontaneous symptomatic pseudoarthrosis of an intervertebral space associated with diffuse idiopathic skeletal hyperostosis, but there have been no reports of surgical treatment for this clinical condition. methods: Plain radiographs of the patient, who was admitted to our hospital with severe back pain but no history of trauma, revealed manifestations of diffuse idiopathic skeletal hyperostosis and a pseudoarthrosis at the T11-T12 intervertebral space. Posterior instrumentation from T9 to L2 and anterior bone grafting at the T11-T12 intervertebral space were performed. RESULTS: The patient has been followed for 4 years and is currently asymptomatic. CONCLUSIONS: A rare case of spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis was treated successfully by spinal fusion.
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4/12. Parasagittal meningioma en plaque with extracranial extension presenting diffuse massive hyperostosis of the skull.

    BACKGROUND: We describe a case of convexity meningioma en plaque (MEP) invading the skull and scalp with diffuse massive hyperostosis, presenting striking radiological findings. CASE DESCRIPTION: A 48-year-old woman was admitted to our hospital with headache, general fatigue, diplopia, and blurred vision. A skull x-ray film, computed tomography (CT), and 3-dimensional CT demonstrated diffuse significant hyperostosis and sclerosis in the cranial vault. Magnetic resonance (MR) imaging revealed a frontoparietal, well-enhanced extra-axial mass lesion, which is compatible with findings of MEP. The tumor was partially resected. Histological examination revealed massive tumor invasion into the dura mater, hyperostotic skull, and scalp. CONCLUSION: hyperostosis is frequently observed in MEP, although there has been no report of a case of MEP such as ours demonstrating diffuse tumor extension and diffuse hyperostosis. Analyzing the CT finding of hyperostotic bone is useful for differentiation of MEP from other diseases that include a hyperostotic condition.
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5/12. Diffuse interstitial skeletal hyperostosis (DISH) in type 2 diabetes.

    A 58 years type 2 diabetic woman, school teacher by profession, presented with backache, neck pain and generalised weakness since last few months. Pain was mild with stiffness and neck pain was particularly associated with extension of the neck towards back. There was no focal neurological deficit on central nervous system examination. X-ray of lumbo- sacral spine showed prolific osteophytes and new bone formation in the body of lumbar vertebrae. Cervical X-ray showed 'Melting candle-wax' appearance at the anterior to the cervical vertebrae. In view of clinical and radiological association the case was diagnosed as DISH syndrome. It is being presented for its rarity.
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6/12. Choking, sore throat with referred otalgia and dysphagia in a patient with diffuse idiopathic skeletal hyperostosis (DISH).

    A patient with a progressively increasing immobilisation of the cervical spine, severe impaired swallowing (choking), sore throat with referred right-sided otalgia, mild voice disorder and dysphagia due to extrinsic bone compression of the posterior hypopharyngeal wall and oesophagus is presented. Radiographic investigation demonstrated the underlying condition to be a diffuse idiopathic skeletal hyperostosis with prominent and bumpy alteration of the anterior longitudinal ligament impinging the hypopharynx. Via an anterolateral approach towards the cervical spine the anterior irregular part of the ossification was removed and the surface of the spine flattened. The postoperative evolution was uneventful.
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7/12. Tardive dystonia and diffuse idiopathic skeletal hyperostosis.

    Tardive dystonia is a late side effect of long term neuroleptic treatment. A Chinese woman with tardive dystonia in the form of retrocollis for ten years showed radiological evidence of diffuse idiopathic skeletal hyperostosis (DISH) in the cervical spine. This association has not been previously reported in the literature. It is postulated that the retrocollis led to an abnormal stress of the cervical spine where excessive bone formation occurred. Hence tardive dystonia may act as a risk factor for DISH in patients who have an ossifying diathesis.
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8/12. Long term follow-up of diffuse idiopathic skeletal hyperostosis in the cervical spine. Analysis of progression of ossification.

    In eleven patients with diffuse idiopathic skeletal hyperostosis who presented with extensive ossification in the cervical spine, progression or regression of ossification during the follow-up period were measured in extent and thickness radiographically. Intervertebral range of motion was also measured and the relation between changes of ossification and intervertebral mobility was analyzed. The range of motion at the segments at which ossification progressed was statistically quite different from those at which no progression was observed. It was found that ossification grew in thickness at mobile segments and no growth of ossification was present at immobile segments. Dysphagia caused by massive ossification was cured by surgical removal in two cases. Recurrent ossifications were detected in them some years after surgery, and one of them complained of dysphagia again. To prevent recurrent ossification and dysphagia, it was considered that immobilization of the concerned segment was necessary by bone grafting or preservation of the continuity of ossification.
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9/12. Multiple peripheral nerve entrapment in Forestier's disease (diffuse idiopathic skeletal hyperostosis).

    A patient with typical diffuse idiopathic skeletal hyperostosis and characteristic new bone formation around the elbows exhibited bilateral ulnar nerve entrapment at these sites as well as median nerve compression at one wrist.
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10/12. Diffuse idiopathic skeletal hyperostosis: an unusual cause of difficult intubation.

    A case is reported in which anterior osteophytes on the cervical vertebra, in combination with a subglottic stenosis, resulted in distortion of the airway and led to unexpected difficulties during intubation. The osteophytes, associated with the syndrome of diffuse idiopathic skeletal hyperostosis (DISH) were centred at the midcervical level and resulted in anterior displacement of the larynx with an acute angulation of the trachea just below the larynx. This acute angulation, immediately above an unrecognized subglottic stenosis, rendered it impossible to pass all but the smallest endotracheal tube. Diffuse idiopathic skeletal hyperostosis is an ossifying diathesis leading to bone formation in spinal and extraspinal sites, paravertebral osteophyte formation and ligamentous calcification and ossification. Ossification of the anterior longitudinal ligament is common, may be discontinuous, and is often more marked in the thoracolumbar spine than elsewhere. However, isolated and predominant cervical spinal involvement may occur. Diffuse idiopathic skeletal hyperostosis occurs primarily in the elderly population and is often associated with the syndromes of osteoarthritis and ossification of the posterior longitudinal ligament (OPLL). Difficult intubation resulting from anatomical abnormalities of the cervical spine is rare. Although radiological evaluation may be useful in assessing the airway in patients deemed to be at risk for difficult intubation, it cannot be recommended for screening patient populations on a routine basis because of the cost and anticipated extremely low yield. Careful clinical evaluation of the airway before operation and having an approach to the unexpected difficult intubation are emphasized.
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