Risk factors for delayed diagnosis of spinal fracture associated with diffuse idiopathic skeletal hyperostosis: A nationwide multiinstitution survey |
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| Institution: | 1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan;2. Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan;3. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan;4. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan;5. Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, 455-8530, Aichi, Japan;6. Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata-shi, 951-8510, Niigata, Japan;7. Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan;8. Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, 649-7113, Wakayama, Japan;9. Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Wakayama, Japan;10. Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, 329-0498, Tochigi, Japan;11. Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita Ward, Okayama, 701-1192, Okayama, Japan;12. Department of Orthopaedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuocho, 892-8502, Kagoshima, Japan;13. Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, 663-8501, Hyogo, Japan;14. Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, 332-8558, Saitama, Japan;15. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Higashi Ward, Hamamatsu, 432-8580, Shizuoka, Japan;p. Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-shi, 409-3898, Yamanashi, Japan;q. Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, 036-8562, Aomori, Japan;r. Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan;s. Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan;t. Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, 160-8402, Tokyo, Japan;u. Department of Orthopaedic Surgery, Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, 152-8902, Tokyo, Japan;1. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. Medical College, Soochow University, Suzhou, Jiangsu, China;1. Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan;2. Department of Orthopaedic and Orthopaedic Rehabilitation, Beijing Bo Ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China;3. Department of Spinal and Neural Function Reconstruction, Beijing Bo Ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China;4. Division of Rehabilitation Medicine, International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan;5. Department of Physical Therapy, Beijing Bo Ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China;6. Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan;1. Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan;2. Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan;1. Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan;2. Department of Orthopaedic Surgery, Saiseika Hospital, Wakayama, Japan;3. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan;1. Laboratory of Musculoskeletal Ultrasound in Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan;2. Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan;3. Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan |
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| Abstract: | BackgroundPatients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH).MethodsThe subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made >24 h after injury.ResultsMain causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p < 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P < 0.05) and Frankel grade E at the time of injury (OR 2.29; P < 0.01) were significantly associated with delayed diagnosis.ConclusionIn patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration. |
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