{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:25:40Z","timestamp":1791973540698,"version":"4.4.0"},"reference-count":30,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["201610008B"],"award-info":[{"award-number":["201610008B"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["16ek0109136h0002"],"award-info":[{"award-number":["16ek0109136h0002"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: This study investigated how diffuse idiopathic skeletal hyperostosis (DISH) influences clinical characteristics in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although DISH is considered unlikely to promote neurologic dysfunction, this relationship remains unclear. Methods: Patient data were prospectively collected from 16 Japanese institutions. In total, 239 patients with cervical OPLL were enrolled who had whole-spine computed tomography images available. The primary outcomes were visual analog scale pain scores and the results of other self-reported clinical questionnaires. Correlations were sought between clinical symptoms and DISH using the following grading system: 1, DISH at T3-T10; 2, DISH at both T3\u201310 and C6\u2013T2 and\/or T11\u2013L2; and 3, DISH beyond the C5 and\/or L3 levels. Results: DISH was absent in 132 cases, grade 1 in 23, grade 2 in 65, and grade 3 in 19. There were no significant correlations between DISH grade and clinical scores. However, there was a significant difference in the prevalence of neck pain (but not in back pain or low back pain) among the three grades. Interestingly, DISH localized in the thoracic spine (grade 1) may create overload at the cervical spine and lead to neck pain in patients with cervical OPLL. Conclusion: This study is the first prospective multicenter cross-sectional comparison of subjective outcomes in patients with cervical OPLL according to the presence or absence of DISH. The severity of DISH was partially associated with the prevalence of neck pain.<\/jats:p>","DOI":"10.3390\/jcm10184137","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T21:47:21Z","timestamp":1631656041000},"page":"4137","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Associations between Clinical Findings and Severity of Diffuse Idiopathic Skeletal Hyperostosis in Patients with Ossification of the Posterior Longitudinal Ligament"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6200-0100","authenticated-orcid":false,"given":"Takashi","family":"Hirai","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soraya","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshitaka","family":"Yoshii","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narihito","family":"Nagoshi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanji","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Shiga University of Medical Science, \u014ctsu 520-2192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Maki","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Chiba University Graduate, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Katsumi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata 951-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"National Hospital Organization Okayama Medical Center, Department of Orthopedic Surgery, Okayama 701-1192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5422-7655","authenticated-orcid":false,"given":"Shuta","family":"Ushio","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeo","family":"Furuya","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Chiba University Graduate, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata 951-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7754-6579","authenticated-orcid":false,"given":"Norihiro","family":"Nishida","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kota","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4882-2997","authenticated-orcid":false,"given":"Takashi","family":"Kaito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4762-5932","authenticated-orcid":false,"given":"Satoshi","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-1192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuya","family":"Nagashima","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masao","family":"Koda","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0039-9678","authenticated-orcid":false,"given":"Hiroaki","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Shouwa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Imagama","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Shouwa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuma","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku, Tokyo 160-8402, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Matsuoka","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku, Tokyo 160-8402, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanichiro","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4948-1792","authenticated-orcid":false,"given":"Atsushi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Jichi Medical University, Shimotsuke 329-0498, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuro","family":"Ohba","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Yamanashi, Chuo 409-3898, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0046-3008","authenticated-orcid":false,"given":"Hiroyuki","family":"Katoh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Surgical Science, School of Medicine, Tokai University, Isehara 259-1193, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9038-0446","authenticated-orcid":false,"given":"Masahiko","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Surgical Science, School of Medicine, Tokai University, Isehara 259-1193, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiro","family":"Matsuyama","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Hamamatsu University, Hamamatsu 431-3125, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Ozawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotaka","family":"Haro","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Yamanashi, Chuo 409-3898, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsushi","family":"Takeshita","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Jichi Medical University, Shimotsuke 329-0498, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morio","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9293-3531","authenticated-orcid":false,"given":"Masashi","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Matsukura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4195-2545","authenticated-orcid":false,"given":"Hiroyuki","family":"Inose","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Okawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiharu","family":"Kawaguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/BRS.0b013e31822da1d5","article-title":"Risk factors for acute cervical spinal cord injury associated with ossification of the posterior longitudinal ligament","volume":"37","author":"Onishi","year":"2012","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3171\/2008.10.SPI08480","article-title":"Cervical myelopathy in patients with ossification of the posterior longitudinal ligament","volume":"10","author":"Mochizuki","year":"2009","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E309","DOI":"10.1097\/BRS.0b013e318241ad33","article-title":"Ossification of the posterior longitudinal ligament of the cervical spine: Etiology and natural history","volume":"37","author":"Matsunaga","year":"2012","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.2214\/ajr.131.6.1049","article-title":"Association of diffuse idiopathic skeletal hyperostosis (DISH) and calcification and ossification of the posterior longitudinal ligament","volume":"131","author":"Resnick","year":"1978","journal-title":"AJR Am. J. 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