Objective: To observe and describe the development and underlying structure of the spinal manifestations of individuals osteologically diagnosed with DISH (Diffuse Idiopathic Skeletal Hyperostosis), using micro-XCT imaging.
Materials: A total of 72 individuals with DISH were identified in two modern skeletal collections in South Africa.
Methods: Vertebral columns affected by DISH were scanned at the micro-focus x-ray computed tomography facility at the Nuclear Energy Corporation of South Africa. Four features were macroscopically examined: (1) the origin of the new bone growth; (2) retention of the original vertebral cortex at the site of the new bone formation associated with DISH; (3) evidence of trabecular bone with or without sclerosis on the anterolateral surface of affected vertebrae; and (4) abnormal areas of osteosclerosis beyond features associated with DISH.
Results: Considerable variation across and between the four recorded features was found. Of note, 81% (n = 58) of individuals had both developed trabecular bone within the flowing new bone formation (feature 3), without retention of the original vertebral cortex (feature 2).
Conclusions: Possible localised erosive/inflammatory processes destroyed the original cortex of the vertebral body and resulted in the expansion of trabeculae with new bone formation.
Significance: Micro-XCT imaging shed new light on the development of DISH, adding to literature suggesting that it could be an inflammatory disease.
Limitations: Clinical histories of the individuals were not known.
Suggestions for further research: The role of chronic inflammatory disease in the development of DISH should be further explored including both the extra-spinal and spinal manifestations.
Keywords: Anterior longitudinal ligament; Dry-bone; Inflammation; Spinal column; Vertebral ankyloses.
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