Eijiro Okada1, Kentaro Shimizu2, Masanori Kato3, Kentaro Fukuda4, Shinjiro Kaneko5, Jun Ogawa6, Mitsuru Yagi7, Nobuyuki Fujita7, Osahiko Tsuji7, Satoshi Suzuki7, Narihito Nagoshi7, Takashi Tsuji8, Masaya Nakamura7, Morio Matsumoto7, Kota Watanabe9. 1. Department of Orthopaedic Surgery, Keio University, Tokyo, Japan; Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 2. Department of Orthopaedic Surgery, Sano General Hospital, Tochigi Japan; Keio Spine Research Group, Tokyo, Japan. 3. Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 4. Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan; Keio Spine Research Group, Tokyo, Japan. 5. Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 6. Department of Orthopaedic Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan; Keio Spine Research Group, Tokyo, Japan. 7. Department of Orthopaedic Surgery, Keio University, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. 8. Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan; Keio Spine Research Group, Tokyo, Japan. 9. Department of Orthopaedic Surgery, Keio University, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. Electronic address: watakota@gmail.com.
Abstract
BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. This study was conducted to assess clinical and radiographic features of spinal fractures in DISH by the level of spinal injury, and to evaluate the optimal treatment for each level. METHODS: A multicenter retrospective study over a 5-year period, including 46 patients (35 males; 11 females) with a mean age of 77.2 ± 9.7 years at the time of injury. By fracture level, there were 7 cervical (15.2%), 25 thoracic (54.3%), and 14 lumbar (30.4%) fractures. We recorded the cause of injury, whether diagnosis was delayed, and neurological status by Frankel grade. Ossification and fracture patterns were assessed by CT-multi-planar reconstruction (MPR). RESULTS: Neurological status immediately after the cervical-spine injury was C (28.6%) or E (71.4%); after thoracic injury, C (12.0%) or E (88.0%); and after lumbar injury, D (21.4%) or E (78.6%). Inability to walk at admission was more frequent in patients with a spinal-cord injury above the lumbar level (P = .033). Vertebral-body fractures were observed in 14.3% of the cervical injuries, 80.0% of the thoracic injuries, and 50.0% of the lumbar injuries (P = .004). Most patients with a cervical fracture had a disc-level fracture (85.7%). Posterior-column ankylosis was observed in 14.3% of the cervical-fracture group, 72.0% of the thoracic-fracture group, and 78.6% of the lumbar-fracture group (P = .008). CONCLUSION: Ossification and fracture patterns in patients with DISH varied distinctly by the level of spinal injury. Intervertebral-disc fractures were frequently observed in the cervical spine. Delayed diagnosis, vertebral-body fracture, and posterior-column ankylosis were observed in the thoracolumbar spine. This study recommends 3 above and 3 below fusion, to avoid instrumentation failure in the fixation of spinal fracture in patients with DISH.
BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. This study was conducted to assess clinical and radiographic features of spinal fractures in DISH by the level of spinal injury, and to evaluate the optimal treatment for each level. METHODS: A multicenter retrospective study over a 5-year period, including 46 patients (35 males; 11 females) with a mean age of 77.2 ± 9.7 years at the time of injury. By fracture level, there were 7 cervical (15.2%), 25 thoracic (54.3%), and 14 lumbar (30.4%) fractures. We recorded the cause of injury, whether diagnosis was delayed, and neurological status by Frankel grade. Ossification and fracture patterns were assessed by CT-multi-planar reconstruction (MPR). RESULTS: Neurological status immediately after the cervical-spine injury was C (28.6%) or E (71.4%); after thoracic injury, C (12.0%) or E (88.0%); and after lumbar injury, D (21.4%) or E (78.6%). Inability to walk at admission was more frequent in patients with a spinal-cord injury above the lumbar level (P = .033). Vertebral-body fractures were observed in 14.3% of the cervical injuries, 80.0% of the thoracic injuries, and 50.0% of the lumbar injuries (P = .004). Most patients with a cervical fracture had a disc-level fracture (85.7%). Posterior-column ankylosis was observed in 14.3% of the cervical-fracture group, 72.0% of the thoracic-fracture group, and 78.6% of the lumbar-fracture group (P = .008). CONCLUSION: Ossification and fracture patterns in patients with DISH varied distinctly by the level of spinal injury. Intervertebral-disc fractures were frequently observed in the cervical spine. Delayed diagnosis, vertebral-body fracture, and posterior-column ankylosis were observed in the thoracolumbar spine. This study recommends 3 above and 3 below fusion, to avoid instrumentation failure in the fixation of spinal fracture in patients with DISH.