Objective

To better understand the pathogenesis of DISH, identifying early or pre-DISH lesions in the spine and investigating the relationship between spinal and extra-spinal manifestations of DISH.

Material

44 skeletonized individuals with DISH from the WM Bass Donated Skeletal Collection.

Methods

For each vertebra, location, extension, point of origin and appearance of vertebral outgrowths were recorded. The size of the enthesophytes at the olecranon process, patella and calcaneal tuberosity was measured with digital callipers.

Results

At either end of the DISH-ankylosed segment, isolated vertical outgrowths arising from the central third of the anterior aspect of the vertebral body can usually be observed. These bone outgrowths show a well-organized external cortical layer, an internal structure of trabecular bone and usually are unaccompanied by or show minimal associated endplate degeneration. Analysis of the relationship between spinal and extra-spinal manifestations (ESM) suggests great inter-individual variability. No correlation between any ESM and the stage of spinal DISH was found.

Conclusions

Small isolated outgrowths represent the earliest stages of the spinal manifestations of DISH. The use of ESM as an indicator of DISH should be undertaken with great caution until the relationship between these two features is understood.

Significance

Improved accuracy of paleopathological diagnostic criteria of DISH.

Limitations

Small sample comprised of only individuals with DISH.

Future research

micro-CT analysis to investigate the internal structure of the spinal lesions. Analysis of extra-spinal enthesophytes in individuals with and without DISH to understand their pathogenesis and association with the spinal lesions in individuals with DISH.

中文翻译：

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回到开始：在椎体强直之前确定弥散性特发性骨骼肥大的病变。

目的

为了更好地了解DISH的发病机制，确定脊柱的早期或DISH病变，并调查DISH的脊柱和脊柱外表现之间的关系。

材料

来自WM Bass捐赠骨骼收藏馆的44名患有DISH的骨骼化个体。

方法

对于每个椎骨，记录其位置，延伸，起源点和椎骨外露的外观。用数字尺测量尺骨鹰嘴突，the骨和跟骨结节处的附生植物的大小。

结果

在DISH强直段的任一端，通常可以观察到椎体前部中央的三分之一产生的孤立的垂直长出。这些骨生长物表现出组织良好的外部皮质层，小梁骨的内部结构，并且通常不伴有终板变性或伴有最小的终板变性。对脊柱和脊柱外表现（ESM）之间关系的分析表明，个体之间存在很大差异。没有发现任何ESM与脊柱DISH分期之间存在相关性。

结论

孤立的小突起代表了DISH脊柱表现的最早阶段。在了解这两个功能之间的关系之前，应格外谨慎地使用ESM作为DISH的指标。

意义

提高了DISH的古病理诊断标准的准确性。

局限性

仅由DISH个人组成的小样本。

未来研究

显微CT分析以研究脊柱病变的内部结构。分析患有和不患有DISH的个体的脊柱外附生植物，以了解其发病机理以及与患有DISH的个体的脊柱病变的关系。