Kimihiko Sawakami1, Kei Watanabe2, Tsuyoshi Sato3, Kazuto Miura4, Keiichi Katsumi5, Noboru Hosaka6, Shinsen Nomura7, Ryuta Fujikawa6, Ren Kikuchi8, Hideki Tashi2, Keitaro Minato1, Hiroyuki Segawa1, Takui Ito1, Seiichi Ishikawa1, Toru Hirano2, Naoto Endo2. 1. Department of Orthopaedic Surgery, Niigata City General Hospital, Niigata, Japan. 2. Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan. 3. Department of Orthopaedic Surgery, Niigata Prefectural Shibata Hospital, Niigata, Japan. 4. Department of Orthopaedic Surgery, Nagaoka Red Cross Hospital, Niigata, Japan. 5. Department of Orthopaedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan. 6. Department of Orthopaedic Surgery, Niigata Prefectural Central Hospital, Niigata, Japan. 7. Department of Orthopaedic Surgery, Mito Saiseikai General Hospital, Ibaraki, Japan. 8. Department of Orthopaedic Surgery, Niigata Rosai Hospital, Niigata, Japan.
Abstract
STUDY DESIGN: Retrospective multi-center study. OBJECTIVE: To identify the morphological features of costovertebral joints and ribs in surgically managed cervical injury patients with diffuse idiopathic skeletal hyperostosis (DISH) and to examine its impact on their vital prognosis. SUMMARY OF BACKGROUND DATA: Several reports have indicated that DISH is an independent risk factor for mortality after spinal fracture. The reason for the high mortality in cervical injury patients with DISH is unclear, although some reports have suggested a possible association between pulmonary complications and mortality. METHODS: From 1999 to 2017, a total of 50 DISH patients (44 males) with cervical spine injuries who underwent spinal surgery were enrolled (average age 74 yrs). Prognosis and clinical risk factor data were collected; the morphological features of the patients' costovertebral joints and ribs were evaluated with computed tomography. The influence of each proposed risk factor and thoracic morphological feature on mortality was tested with univariate and multivariate analyses. RESULTS: The survival rate at 5 years after surgery was 52.3%. Nineteen (38%) patients died, and the most common cause of death was pneumonia (68%). Costovertebral bone excrescences and rib hyperostosis were found to be thoracic pathognomonic signs; their frequencies were 94% and 82%, respectively, and these conditions occurred in an average of 7.0 joints and 4.7 bones, respectively. The results of the log-rank test showed a significant difference in age, injury severity score (ISS), costovertebral bone excrescences, and rib hyperostosis. The results of age-adjusted multivariate analysis indicated that age (hazard ratio [HR] = 8.65, 95% confidence interval [CI] = 1.10-68.28, P = 0.041) and rib hyperostosis (HR = 3.82, 95% CI = 1.38-10.57, P = 0.010) were associated with mortality. CONCLUSION: Reduced chest wall mobility associated with rib hyperostosis in cervical spine injury patients with DISH leads to a poor prognosis. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Retrospective multi-center study. OBJECTIVE: To identify the morphological features of costovertebral joints and ribs in surgically managed cervical injurypatients with diffuse idiopathic skeletal hyperostosis (DISH) and to examine its impact on their vital prognosis. SUMMARY OF BACKGROUND DATA: Several reports have indicated that DISH is an independent risk factor for mortality after spinal fracture. The reason for the high mortality in cervical injurypatients with DISH is unclear, although some reports have suggested a possible association between pulmonary complications and mortality. METHODS: From 1999 to 2017, a total of 50 DISH patients (44 males) with cervical spine injuries who underwent spinal surgery were enrolled (average age 74 yrs). Prognosis and clinical risk factor data were collected; the morphological features of the patients' costovertebral joints and ribs were evaluated with computed tomography. The influence of each proposed risk factor and thoracic morphological feature on mortality was tested with univariate and multivariate analyses. RESULTS: The survival rate at 5 years after surgery was 52.3%. Nineteen (38%) patients died, and the most common cause of death was pneumonia (68%). Costovertebral bone excrescences and rib hyperostosis were found to be thoracic pathognomonic signs; their frequencies were 94% and 82%, respectively, and these conditions occurred in an average of 7.0 joints and 4.7 bones, respectively. The results of the log-rank test showed a significant difference in age, injury severity score (ISS), costovertebral bone excrescences, and rib hyperostosis. The results of age-adjusted multivariate analysis indicated that age (hazard ratio [HR] = 8.65, 95% confidence interval [CI] = 1.10-68.28, P = 0.041) and rib hyperostosis (HR = 3.82, 95% CI = 1.38-10.57, P = 0.010) were associated with mortality. CONCLUSION: Reduced chest wall mobility associated with rib hyperostosis in cervical spine injurypatients with DISH leads to a poor prognosis. LEVEL OF EVIDENCE: 3.