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Diffuse Idiopathic Skeletal Hyperostosis Extended to the Lumbar Segment Is a Risk Factor of Reoperation in Patients Treated Surgically for Lumbar Stenosis

Yamada, Kentaro MD, PhD∗,†; Satoh, Shigenobu MD; Abe, Yuichiro MD, PhD; Yanagibashi, Yasushi MD; Hyakumachi, Takahiko MD; Masuda, Takeshi MD, PhD

doi: 10.1097/BRS.0000000000002618

Study Design. Retrospective longitudinal cohort study.

Objective. To investigate the association between diffuse idiopathic skeletal hyperostosis (DISH) and reoperation in patients treated surgically for lumbar spinal stenosis (LSS) in long-term results.

Summary of Background Data. Few studies have evaluated DISH as a potential risk factor of poor surgical results for LSS.

Methods. This study included 1063 responders to a postoperative postal survey out of 2363 consecutive patients who underwent surgery for LSS between 2002 and 2010. The survey included questions about reoperations performed at another hospital and the patient-reported outcomes. DISH was evaluated by preoperative standing whole-spine radiographs. We investigated DISH as a predictor of reoperation and characteristics of poor outcomes in patients with DISH. We also assessed selection bias by examining the differences between responders and nonresponders to a postal survey.

Results. Reoperations were performed in a total of 115 patients (10.8%) within an average of 8.6 years after the initial surgeries. Patients who only had DISH were not associated with reoperation; however, reoperations were performed significantly more often in patients with DISH extended to the lumbar segment (L-DISH) than in patients without (22% and 7.3%, respectively; P < 0.001). Cox analysis showed that L-DISH was one of the significant independent predictors for reoperation (hazard ratio 2.05, P = 0.009). Surgery-free survival was significantly shorter in patients with L-DISH than in those without (P = 0.005). The cause of reoperation did not differ between the patients with and without L-DISH. Several factors, but not L-DISH, were significantly associated with responders to the survey.

Conclusion. L-DISH was independently associated with reoperation for LSS. The decreased number of lumbar mobile segments due to L-DISH might lead to unfavorable outcomes. Careful follow-up of patients is needed after surgery for LSS with L-DISH.

Level of Evidence: 3

Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido, Japan

Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan.

Address correspondence and reprint requests to Kentaro Yamada, MD, PhD, Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; E-mail: address:

Received 23 October, 2017

Revised 17 January, 2018

Accepted 20 February, 2018

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.