Background: Concomitant diffuse idiopathic skeletal hyperostosis (DISH) and cervical ossification of the posterior longitudinal ligament (cOPLL) is primarily investigated in radiographic studies of East Asian populations. This study aimed to determine clinical prevalence of concomitant DISH/cOPLL in a large U.S. sample and to compare characteristics and complications in cOPLL patients with and without concomitant DISH who were surgically treated.
Methods: A retrospective database study was performed using PearlDiver. Billing codes identified cOPLL patients with and without concomitant DISH during 2010-2022. Annual prevalence was calculated. Patients undergoing cervical/thoracic spine decompression with/without fusion were included. Bivariate analyses compared patient characteristics, 1-year reoperation, and cohort-matched 90-day complications.
Results: 681 cOPLL patients had concomitant DISH and 28,395 did not. Prevalence of DISH in patients with cOPLL was 1.4%. cOPLL patients with DISH underwent surgery more frequently than those without (30.2% vs. 21.7%; p<0.0001) via posterior approach (68.0% vs. 42.1%; p<0.0001). cOPLL patients with DISH undergoing surgery were more frequently male (71.0% vs. 51.6%; p<0.0001) with higher proportion of metabolic syndrome (61.4% vs. 37.9%; p<0.0001). Compared to cOPLL patients without DISH, cOPLL patients with DISH had similar 1-year reoperation (8.3% vs. 9.6%; p=0.61) and post-match 90-day complications (17.8% vs. 14.2%; p=0.31), yet higher overall neurological injury (14.7% vs. 6.9%; p=0.0047) amid infrequent procedure-related neurological injury (2.3% vs. 0.6%; p=0.08).
Conclusion: Clinical prevalence of DISH in patients with cOPLL in the U.S. is low, yet cOPLL patients with concomitant DISH underwent surgery more frequently compared to those without. Despite higher comorbidity burden, cOPLL patients with DISH may have similar short-term post-surgical risk to cOPLL patients without DISH. However, higher non-procedural neurological injury in cOPLL patients with DISH may indicate insidious or delayed disease sequelae.
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