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Diffuse Idiopathic Skeletal Hyperostosis Association With Thoracic Spine Kyphosis: A Cross-sectional Study for the Health Aging and Body Composition Study

Nardo, Lorenzo, MD*; Lane, Nancy E., MD; Parimi, Neeta, MS; Cawthon, Peggy M., PhD; Fan, Bo, MD§; Shepherd, John, PhD§; Cauley, Jane, DrPH; Zucker-Levin, Audrey, PT, PhD; Murphy, Rachel A., PhD**; Katzman, Wendy B., PT, DPTSc††

doi: 10.1097/BRS.0000000000000615
Deformity
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Study Design. A descriptive study of the association between diffuse idiopathic skeletal hyperostosis (DISH) and kyphosis.

Objective. To investigate the association of DISH with Cobb angle of kyphosis in a large cohort of older subjects from the Health Aging and Body Composition Study.

Summary of Background Data. DISH and thoracic kyphosis are well-defined radiographical findings in spines of older individuals. Characteristics of DISH (ossifications between vertebral segments) reflect changes of spine anatomy and physiology that may be associated with Cobb angle of kyphosis.

Methods. Using data from 1172 subjects aged 70 to 79 years, we measured DISH and Cobb angle of kyphosis from computed tomographic lateral scout scans. Characteristics of participants with and without DISH were assessed using the χ2 and t tests. Association between DISH and Cobb angle was analyzed using linear regression. Cobb angle and DISH relationship was assessed at different spine levels (thoracic and lumbar).

Results. DISH was identified on computed tomographic scout scan in 152 subjects with 101 cases in only the thoracic spine and 51 in both thoracic and lumbar spine segments. The mean Cobb angle of kyphosis in the analytic sample was 31.3° (standard deviation = 11.2). The presence of DISH was associated with a greater Cobb angle of 9.1° and 95% confidence interval (95% CI) (5.6–12.6) among African Americans and a Cobb angle of 2.9° and 95% CI (0.5–5.2) among Caucasians compared with those with no DISH. DISH in the thoracic spine alone was associated with a greater Cobb angle of 10.6° and 95% CI (6.5–14.7) in African Americans and a Cobb angle of 3.8° and 95% CI (1.0–6.5) in Caucasians compared with those with no DISH.

Conclusion. DISH is associated with greater Cobb angle of kyphosis, especially when present in the thoracic spine alone. The association of DISH with Cobb angle is stronger within the African American population.

Level of Evidence: 3

An investigation of older individuals from the Health Aging and Body Composition Study demonstrated that diffuse idiopathic skeletal hyperostosis is associated with greater Cobb angle of kyphosis in the thoracic spine and this association is stronger within the African American population.

*Department of Radiology, University of California San Francisco, San Francisco, CA

Center for Musculoskeletal Health, University of California at Davis School of Medicine, Sacramento, CA

California Pacific Medical Research Center, San Francisco, CA

§Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

Department of Physical Therapy, College of Allied Health Sciences, The University of Tennessee Health Science Center, Memphis, TN

**Laboratory of Epidemiology, and Population Sciences, National Institute on Aging, Bethesda, MD; and

††Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA.

Address correspondence and reprint requests to Wendy B. Katzman, PT, DPTSc, Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens St. Suite 400, San Francisco, CA 94158; E-mail: wendy.katzman@ucsf.edu

Acknowledgment date: March 12, 2014. First revision date: June 16, 2014. Second revision date: July 18, 2014. Acceptance date: September 1, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

National Institute on Aging (NIA) Contracts N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106; NIA grants R01-AG028050, RO1 AG041921; National Institute of Nursing Research (NINR) grant R01-NR-012459; NIH grants AR043052 and K24AR04884, P50 AR060752, Office of Research in Women's Health and the National Institute of Arthritis, Musculoskeletal, and Skin Diseases P50 grant AR063043 funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for lectures.

© 2014 by Lippincott Williams & Wilkins