• Masahito Kawabori, Kazutoshi Hida, Minoru Akino, Shunsuke Yano, Hisatoshi Saito, and Yoshinobu Iwasaki.
• Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. masahitokawabori@yahoo.co.jp.ca
• Spine. 2009 Sep 1; 34 (19): E709-11.

Study DesignA unique case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) associated with C1 posterior tubercle impingement resulting in spinal canal stenosis and cervical myelopathy.ObjectiveTo describe an uncommon mechanism of spinal cord compression in patient with DISH.Summary Of Background DataThe neurologic deficits due to cervical DISH are relatively rare and a few cases of cervical spinal cord compression due to atlantoaxial subluxation, odontoid fracture, pseudotumor, ligamentous hypertrophy, and basilar impression have been reported. To the best of our knowledge, there has been no other report of a patient with DISH causing C1 posterior tubercle impingement and cervical myelopathy.MethodsA 75-year-old Japanese man, first diagnosed as hyperostosis of anterior and posterior longitudinal ligament 25 years ago, presented with gradual progression of numbness in both lower extremities, disturbed precise hand motion and urinary function. DISH, OPLL, and C1 posterior tubercle impingement was diagnosed by radiograph, CT, and MRI. Hyperintense signal in the C1 spinal cord on T2 weighted sequence was observed.ResultLaminectomy from C1-C3 was performed. Myelocompression and myelopathy improved after the surgical intervention. Multilevel fusion of the subaxial cervical spine and increase of the mechanical stress on the craniocervical segment may leads to partial damage of the ligaments and resulted in C1 posterior arch impingement.ConclusionThis is the first report of unique C1 posterior tubercle impingement and myelopathy caused by DISH. We should keep it in mind that DISH can cause serious problems in the upper cervical spine even after 25 years of interval.

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