CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis |
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Authors: | Eijiro Okada Takashi Tsuji Kentaro Shimizu Masanori Kato Kentaro Fukuda Shinjiro Kaneko Jun Ogawa Kota Watanabe Ken Ishii Masaya Nakamura Morio Matsumoto |
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Institution: | 1. Dept. of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan;2. Dept. of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan;3. Dept. of Orthopaedic Surgery, Sano General Hospital, Tochigi, Japan;4. Dept. of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan;5. Dept. of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan;6. Dept. of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan;7. Dept. of Orthopaedic Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan;8. Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan;9. Keio Spine Research Group, Tokyo, Japan |
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Abstract: | PurposeTo 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.MethodsThis 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.ResultsMost 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.ConclusionsCT-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. |
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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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