• Bungo Otsuki, Shunsuke Fujibayashi, Mitsuru Takemoto, Hiroaki Kimura, Takayoshi Shimizu, and Shuichi Matsuda.
• Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, Japan. bungo@kuhp.kyoto-u.ac.jp.
• Eur Spine J. 2015 Nov 1; 24 (11): 2514-9.

PurposeTo elucidate the effect of diffuse idiopathic skeletal hyperostosis (DISH) on the clinical results of short-segment lumbar interbody fusion (LIF) for the treatment of degenerative lumbar spinal diseases.MethodsThe 208 patients who underwent one- or two-level LIF were selected as the subjects of this study. Patients with prior lumbar fusion surgery or follow-up <1 year were excluded. Outcome measures were surgery-free survival or the need for further surgery for pseudoarthrosis and/or adjacent segment disease (ASD). The Cox proportional-hazards model was used to identify possible risk factors (DISH, age, sex, number of levels fused, level of the lowest instrumented vertebra, and laminectomy adjacent to the index fused levels) for further surgery.ResultsAmong the 208 patients (39 with DISH), 21 patients required further surgery during follow-up. Cox analysis showed that DISH (hazard ratio = 5.46) and two-level fusion (hazard ratio = 2.83) were significant independent predictors of further surgery. Age, sex, level of the lowest instrumented vertebra, and laminectomy adjacent to the index fused levels were not significant predictors.ConclusionsDISH after short-segment LIF surgery is a significant risk factor for further surgery because of pseudoarthrosis or ASD.

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