ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Association of diffuse idiopathic skeletal hyperostosis with postoperative outcomes following surgery for degenerative lumbar spine disease.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
objectiveTo determine whether diffuse idiopathic skeletal hyperostosis (DISH), particularly when extending into the lumbar spine (L-DISH), is associated with postoperative outcomes after surgery for degenerative lumbar disease.
methodsMultiple bibliographic, trial, and Japanese literature databases were searched from inception through June 30, 2026. Comparative DISH or L-DISH studies and within-DISH prognostic or surgical-strategy studies were eligible. Decompression and short-segment interbody fusion evidence were analyzed separately, and overlapping cohorts were resolved for each outcome. Study-specific adjusted estimates were prioritized for inference. Crude risk ratios (RRs) from unadjusted event counts were retained only as secondary, illustrative k = 2 syntheses. Risk of bias was assessed at the result level, and certainty was graded by outcome.
resultsFifteen reports representing 12 independent studies, all retrospective and from Japan, were included. Adjusted study-specific associations for reoperation pointed toward higher risk with DISH/L-DISH after short-segment fusion (hazard ratio [HR], 5.46; 95% confidence interval [CI], 2.25-13.30), mixed lumbar procedures (HR, 2.049; 95% CI, 1.199-3.503), and decompression (HR, 3.37; 95% CI, 1.31-8.69), but effect measures, adjustment sets, and time horizons differed and were not pooled. Secondary crude syntheses contained only 2 cohorts each: decompression RR, 2.50 (95% CI, 1.53-4.08), and fusion RR, 3.93 (95% CI, 2.00-7.70). Modified Hartung-Knapp intervals were 0.10-60.12 and 0.05-310.05, respectively. Radiographic nonunion or pseudarthrosis estimates differed markedly (RR, 12.44; 95% CI, 4.39-35.32; and RR, 1.75; 95% CI, 1.07-2.88) and were not pooled. Certainty was very low.
conclusionPrimary adjusted associations and supportive crude observational estimates were directionally consistent with greater reoperation risk, but sparse data, incomplete confounding control, time-dependent outcome handling, and an exclusively Japanese evidence base make the magnitude uncertain and limit transportability. DISH/L-DISH may be regarded as a possible risk marker, not a causal determinant or a basis for a universal operative strategy. PROSPERO NUMBER: CRD420261454437.
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