Diffuse idiopathic spinal hyperostosis (DISH) causes various problems, such as adjacent disc dysfunction, pseudarthrosis, or reossification, when spinal surgery is performed or spinal fracture occurs. The authors herein describe a patient with DISH in whom ossification of the anterior longitudinal ligament progressively advanced from the thoracic to sacral vertebrae during a 14-year period. Surgery was performed three times to treat the characteristic problems associated with DISH: abnormal sagittal alignment of the spine, ossification of the posterior longitudinal ligament, reossification of the laminectomy-treated regions and accompanying spinal canal stenosis, pseudarthrosis after spinal fracture, and delayed palsy. DISH-associated problems after spinal fusion are not rare, but this patient developed a particularly large number of problems often seen in the long term after spinal fusion in patients with DISH. Clinicians must be aware of problems being likely to occur in ossification-discontinuous and fragile regions during the postoperative follow-up.
Keywords: Diffuse idiopathic hyperostosis; complication; delayed palsy; fracture; lumbar lordosis; lumbar operation; ossification of ligament; pseudarthrosis; sagittal vertical axis; thoracic kyphosis.