Eijiro Okada1, Takashi Tsuji2, Kentaro Shimizu3, Masanori Kato4, Kentaro Fukuda5, Shinjiro Kaneko6, Jun Ogawa7, Kota Watanabe8, Ken Ishii8, Masaya Nakamura8, Morio Matsumoto9. 1. Dept. of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 2. Dept. of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 3. Dept. of Orthopaedic Surgery, Sano General Hospital, Tochigi, Japan; Keio Spine Research Group, Tokyo, Japan. 4. Dept. of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 5. Dept. of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan; Keio Spine Research Group, Tokyo, Japan. 6. Dept. of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 7. Dept. of Orthopaedic Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan; Keio Spine Research Group, Tokyo, Japan. 8. Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 9. Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. Electronic address: morio@a5.keio.jp.
Abstract
PURPOSE: To clarify correlations between spinal fracture and delayed paralysis in patients with diffuse idiopathic skeletal hyperostosis (DISH) using computed tomography (CT) with multiplanar reformatting (CT-MPR). DISH increases susceptibility to unstable spinal fractures, leading to neurological deterioration. The pathomechanism of the neurological injury is unclear. METHODS: This multicenter retrospective study included 42 DISH patients (32 male; 10 female) treated for 45 spinal fractures during a 5-year period. The mean age at the time of injury was 77.1 ± 10.1 years. The cause of injury, delay in diagnosis, fracture location, and neurological status were recorded, and anterior- and posterior-column fractures, a fracture displacement over 3 mm, and posterior-column ankylosis were assessed using CT-MPR. RESULTS: Most fractures (73.8%) resulted from trivial trauma, such as falling from a standing or sitting position. Diagnosis was delayed in 47.6% of the patients, primarily due to delays in seeking medical attention (65.0%). Although 78.6% of the patients were neurologically intact at the time of injury, 54.8% developed paralysis, defined by a change in one or more Frankel-score levels during short-term follow-up. Of the fractures, 39.1% were in the vertebral body, and 60.9% were at the disc level. Fractures with posterior-column ankylosis were significantly associated with delayed paralysis. CONCLUSIONS: CT-MPR was useful for evaluating spinal fractures and determining treatment in patients with DISH. Fractures associated with posterior-column ankylosis resulted in unstable three-column injuries that led to delayed neurological deterioration. Early surgical stabilization of such fractures is recommended to avoid delayed paralysis.
PURPOSE: To clarify correlations between spinal fracture and delayed paralysis in patients with diffuse idiopathic skeletal hyperostosis (DISH) using computed tomography (CT) with multiplanar reformatting (CT-MPR). DISH increases susceptibility to unstable spinal fractures, leading to neurological deterioration. The pathomechanism of the neurological injury is unclear. METHODS: This multicenter retrospective study included 42 DISH patients (32 male; 10 female) treated for 45 spinal fractures during a 5-year period. The mean age at the time of injury was 77.1 ± 10.1 years. The cause of injury, delay in diagnosis, fracture location, and neurological status were recorded, and anterior- and posterior-column fractures, a fracture displacement over 3 mm, and posterior-column ankylosis were assessed using CT-MPR. RESULTS: Most fractures (73.8%) resulted from trivial trauma, such as falling from a standing or sitting position. Diagnosis was delayed in 47.6% of the patients, primarily due to delays in seeking medical attention (65.0%). Although 78.6% of the patients were neurologically intact at the time of injury, 54.8% developed paralysis, defined by a change in one or more Frankel-score levels during short-term follow-up. Of the fractures, 39.1% were in the vertebral body, and 60.9% were at the disc level. Fractures with posterior-column ankylosis were significantly associated with delayed paralysis. CONCLUSIONS: CT-MPR was useful for evaluating spinal fractures and determining treatment in patients with DISH. Fractures associated with posterior-column ankylosis resulted in unstable three-column injuries that led to delayed neurological deterioration. Early surgical stabilization of such fractures is recommended to avoid delayed paralysis.
Authors: George R Milner; Jesper L Boldsen; Stephen D Ousley; Sara M Getz; Svenja Weise; Peter Tarp; Dawnie W Steadman Journal: PLoS One Date: 2018-08-28 Impact factor: 3.240