Abstract
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 wellorganized
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 extraspinal
enthesophytes in individuals with and without DISH to understand their pathogenesis and association
with the spinal lesions in individuals with DISH.
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 wellorganized
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 extraspinal
enthesophytes in individuals with and without DISH to understand their pathogenesis and association
with the spinal lesions in individuals with DISH.
| Original language | English |
|---|---|
| Pages (from-to) | 59-68 |
| Journal | International Journal of Paleopathology |
| Volume | 28 |
| Early online date | 14 Jan 2020 |
| DOIs | |
| Publication status | E-pub ahead of print - 14 Jan 2020 |
Keywords
- DISH
- spinal manifestations
- extra-spinal manifestations
- vertebral bone outgrowths
- vertebral endplate degeneration
- vertebral ankylosis
- enthesophytes