Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey |
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| Authors: | Eijiro Okada Toshitaka Yoshii Tsuyoshi Yamada Kei Watanabe Keiichi Katsumi Akihiko Hiyama Masahiko Watanabe Yukihiro Nakagawa Motohiro Okada Teruaki Endo Yasuyuki Shiraishi Kazuhiro Takeuchi Shunji Matsunaga Keishi Maruo Kenichiro Sakai Sho Kobayashi Tetsuro Ohba Kanichiro Wada Kota Watanabe |
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| Institution: | 1. Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan;2. Dept. of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan;3. Dept. of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan;4. Dept. of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan;5. Dept. of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan;6. Dept. of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan;7. Dept. of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan;8. Dept. of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan;9. Dept. of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan;10. Dept. of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan;11. Dept. of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan;12. Dept. of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan;13. Dept. of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan;14. Dept. of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan;15. Dept. of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan;p. Dept. of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan;q. Dept. of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan;r. Dept. of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan;s. Dept. of Orthopaedic Surgery, Fujita Health University, Aichi, Japan;t. Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan |
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| Abstract: | BackgroundDiffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH.MethodsPatients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years).ResultsThe major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically.ConclusionsMinor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery. |
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| Keywords: | Corresponding author Dept of Orthopaedic Surgery Keio University Shinanomachi 35 Shinjuku-ku Tokyo 160-8582 Japan Fax: +81 3 3353 6597 |
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