Cervical myelopathy in diffuse idiopathic skeletal hyperostosis

Case report

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✓ The case of a rapidly progressive cervical myelopathy in a 64-year-old man is presented. Radiological studies revealed a partial extradural block, which at surgery was found to be a focal fibrous, calcified mass associated with the ligamentum flavum. On the basis of the underlying disorder of diffuse idiopathic skeletal hyperostosis (DISH), the etiology of this compression was concluded to be focal fibrous proliferation and dystrophic calcification. The neurological complications of DISH are reviewed. The authors are not aware of any other reports of this cause of myelopathy associated with DISH.

Article Information

Address reprint requests to: Michael T. Stechison, M.D., Ph.D., Division of Neurologic Surgery, N-950 Doan Hall, 410 West 10th Avenue, Columbus, Ohio 43210-1228.

© AANS, except where prohibited by US copyright law.

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Figures

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    Lateral radiograph revealing flowing calcification along the anterior longitudinal ligament extending over more than four contiguous segments in the thoracic and lumbar portions of the spine (arrows). Disc height is seen to be relatively preserved.

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    Left: Cervical myelogram, lateral view, showing almost complete extradural obstruction to contrast flow at the C-4 level. The vertebral alignment is good and paravertebral calcification is minimal. Right: Postmyelogram axial computerized tomography scan at the C-4 level showing a posterior extradural mass causing marked spinal cord deformation (arrow).

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    Low-power photomicrograph demonstrating granulation tissue and degenerative changes in the ligamentum flavum (lower right half), with more normal ligamentum (upper left). H & E, × 6.5.

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