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Diffuse idiopathic skeletal hyperostosis in ancient clergymen.

Verlaan JJ, Oner FC, Maat GJ - Eur Spine J (2007)

Bottom Line: The authors reviewed all available material and after reaching consensus, each abnormality found was given a diagnosis and subsequently recorded.The mean age at death for adults was 36.8 years.The mean age of these individuals was 49.5 +/- 13.0 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. jj.verlaan@wxs.nl

ABSTRACT
Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral enthesopathies are present. The etiology of DISH is unknown but previous studies have shown a strong association with obesity and insulin-independent diabetes mellitus. DISH can lead to back pain, dysphagia, myelopathy, musculoskeletal impairment and grossly unstable spine fractures after minor trauma. In archeological studies a high prevalence of DISH has been demonstrated in ancient clergymen. The present study describes the pathological changes of human remains excavated from the abbey court (Pandhof) in the city of Maastricht, The Netherlands. Human remains of 51 individuals buried between 275 and 1795 CE: were excavated and examined. The remains were investigated according to a standardized physical anthropological report and individuals demonstrating ossification of spinal ligaments and/or multiple peripheral enthesopathies were included in the study group. The authors reviewed all available material and after reaching consensus, each abnormality found was given a diagnosis and subsequently recorded. After examination, 28 individuals were considered to be adult males; 11 adult females; three adults of indeterminate sex and nine individuals were of sub adult age. The mean age at death for adults was 36.8 years. Seventeen adult individuals (40.4% of all adults), displayed ossifications of at least four contiguous spinal levels and/or multiple enthesopathies of the appendicular skeleton and were therefore, assigned the diagnosis DISH. The mean age of these individuals was 49.5 +/- 13.0 years. In at least three of these individuals, DISH had led to extensive ossification and subsequent ankylosis of axial and peripheral skeletal structures. In this population of (presumably) clergymen and high-ranking citizens, DISH was observed in unusual high numbers at a relatively young age. Some of the examined cases suggest that DISH may be a seriously incapacitating disorder when the more advanced stages of the disease have been reached. It is hypothesized that "a monastic way of life" can predispose to DISH. Present demographic trends in obesity and diabetes mellitus as potential co-factors for the development of DISH warrant further study to investigate its future prevalence.

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Related in: MedlinePlus

Photograph of skeletal remains from a 57 year-old-female (grave 44) showing ossification of the anterior longitudinal ligament exhibiting the typical ‘flowing wax’ phenomenon
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Fig4: Photograph of skeletal remains from a 57 year-old-female (grave 44) showing ossification of the anterior longitudinal ligament exhibiting the typical ‘flowing wax’ phenomenon

Mentions: A 57 year-old-female was buried in grave 44. This individual showed sacralization of the fifth lumbar vertebra and osteochondritis dissecans of the left glenohumeral joint and the left knee joint. DISH was diagnosed by multiple level ossification of the anterior longitudinal ligament at the thoracic level, which showed the typical ‘flowing wax’ phenomenon known from clinical radiological examinations (Fig. 4).Fig. 4


Diffuse idiopathic skeletal hyperostosis in ancient clergymen.

Verlaan JJ, Oner FC, Maat GJ - Eur Spine J (2007)

Photograph of skeletal remains from a 57 year-old-female (grave 44) showing ossification of the anterior longitudinal ligament exhibiting the typical ‘flowing wax’ phenomenon
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2200769&req=5

Fig4: Photograph of skeletal remains from a 57 year-old-female (grave 44) showing ossification of the anterior longitudinal ligament exhibiting the typical ‘flowing wax’ phenomenon
Mentions: A 57 year-old-female was buried in grave 44. This individual showed sacralization of the fifth lumbar vertebra and osteochondritis dissecans of the left glenohumeral joint and the left knee joint. DISH was diagnosed by multiple level ossification of the anterior longitudinal ligament at the thoracic level, which showed the typical ‘flowing wax’ phenomenon known from clinical radiological examinations (Fig. 4).Fig. 4

Bottom Line: The authors reviewed all available material and after reaching consensus, each abnormality found was given a diagnosis and subsequently recorded.The mean age at death for adults was 36.8 years.The mean age of these individuals was 49.5 +/- 13.0 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. jj.verlaan@wxs.nl

ABSTRACT
Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral enthesopathies are present. The etiology of DISH is unknown but previous studies have shown a strong association with obesity and insulin-independent diabetes mellitus. DISH can lead to back pain, dysphagia, myelopathy, musculoskeletal impairment and grossly unstable spine fractures after minor trauma. In archeological studies a high prevalence of DISH has been demonstrated in ancient clergymen. The present study describes the pathological changes of human remains excavated from the abbey court (Pandhof) in the city of Maastricht, The Netherlands. Human remains of 51 individuals buried between 275 and 1795 CE: were excavated and examined. The remains were investigated according to a standardized physical anthropological report and individuals demonstrating ossification of spinal ligaments and/or multiple peripheral enthesopathies were included in the study group. The authors reviewed all available material and after reaching consensus, each abnormality found was given a diagnosis and subsequently recorded. After examination, 28 individuals were considered to be adult males; 11 adult females; three adults of indeterminate sex and nine individuals were of sub adult age. The mean age at death for adults was 36.8 years. Seventeen adult individuals (40.4% of all adults), displayed ossifications of at least four contiguous spinal levels and/or multiple enthesopathies of the appendicular skeleton and were therefore, assigned the diagnosis DISH. The mean age of these individuals was 49.5 +/- 13.0 years. In at least three of these individuals, DISH had led to extensive ossification and subsequent ankylosis of axial and peripheral skeletal structures. In this population of (presumably) clergymen and high-ranking citizens, DISH was observed in unusual high numbers at a relatively young age. Some of the examined cases suggest that DISH may be a seriously incapacitating disorder when the more advanced stages of the disease have been reached. It is hypothesized that "a monastic way of life" can predispose to DISH. Present demographic trends in obesity and diabetes mellitus as potential co-factors for the development of DISH warrant further study to investigate its future prevalence.

Show MeSH
Related in: MedlinePlus