CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis

Okada, Eijiro; Tsuji, Takashi; Shimizu, Kentaro; Kato, Masanori; Fukuda, Kentaro; Kaneko, Shinjiro; Ogawa, Jun; Watanabe, Kota; Ishii, Ken; Nakamura, Masaya; Matsumoto, Morio

doi:10.1016/j.jos.2016.09.011

Cited by 38 publications

(36 citation statements)

References 15 publications

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“…With plain radiographs, spinal fractures in DISH can be easily missed; therefore, a CT scan of the entire spinal column is recommended if a fracture is suspected. MRI scans are helpful in case of suspicion of occult fractures that are difficult to detect with CT 15. Hyperextension is the predominant fracture mechanism in DISH (Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B3), a configuration which generally requires long-segment surgical fixation to provide sufficient mechanical stability to allow for fracture healing and prevent (further) neurological deficits.…”

Section: Dish and Spinal Fracturesmentioning

confidence: 99%

Imaging of diffuse idiopathic skeletal hyperostosis (DISH)

et al. 2020

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Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterised by calcification and ossification of ligaments and entheses. The condition usually affects the axial skeleton, in particular, at the thoracic segment, though also other portions of the spine are often involved. DISH often involves also peripheral tendinous and/or entheseal sites either alone, or in association with the involvement of peripheral joints. At times, new bone formation involves the bone itself, but sometimes it involves joints not usually affected by osteoarthritis (OA) which result in bony enlargement of the epiphysis, joints space narrowing and a reduced range of motion. Because of the entheseal involvement, DISH can be mistaken for seronegative spondyloarthropathies or for a "simple" OA. Furthermore, other implications for the recognition of DISH include spinal fractures, difficult intubation and upper endoscopies, decreased response rates in DISH with concomitant spondyloarthritides, and increased likelihood to be affected by metabolic syndrome and cardiovascular diseases. This Atlas is intended to show the imaging finding in DISH in patients diagnosed with the condition by the Resnick classification criteria.

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Section: Dish and Spinal Fracturesmentioning

confidence: 99%

Imaging of diffuse idiopathic skeletal hyperostosis (DISH)

et al. 2020

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“…5 In DISH patients, trivial trauma can cause serious spinal fractures that carry a high risk for delayed paralysis and perioperative complications. [6][7][8][9][10] We recently observed that among elderly people with DISH-related spinal fractures (mean age 77.1 + 10.1 years), 47.6% were affected by delayed paralysis. 6 We examined these injuries by computed tomography (CT) with multiplanar reformatting (CT-MPR) and concluded that spinal fractures in regions with posterior-column ankylosis led to three-column injuries and delayed paralysis.…”

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confidence: 99%

“…[6][7][8][9][10] We recently observed that among elderly people with DISH-related spinal fractures (mean age 77.1 + 10.1 years), 47.6% were affected by delayed paralysis. 6 We examined these injuries by computed tomography (CT) with multiplanar reformatting (CT-MPR) and concluded that spinal fractures in regions with posterior-column ankylosis led to three-column injuries and delayed paralysis. As with fractures in long bones, the long lever arm formed by the ossified spine increases the mechanical stress at the fracture, destabilizing the spine even further.…”

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confidence: 99%

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Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation

Okada

Shiono

Nishida

et al. 2019

J Orthop Surg (Hong Kong)

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To validate the effectiveness of percutaneous pedicle screw (PPS) fixation for spinal fractures associated with diffuse idiopathic skeletal hyperostosis (DISH) by comparing surgical outcomes for PPS fixation and conventional open posterior fixation. Patients with DISH are vulnerable to unstable spinal fractures caused by trivial trauma, and these fractures have high rates of delayed paralysis, postoperative complications, and mortality. Methods: This retrospective study assessed surgical outcomes for 16 patients with DISH (12 men; mean age 76.1 + 9.4 years) who underwent PPS fixation for spinal fractures (pedicle screw (PS) group), and for a control group of 25 patients with DISH (18 men; mean age 77.9 + 9.9 years) who underwent conventional open fixation (O group) at our affiliated hospitals from 2007 to 2017. We evaluated the preoperative physical condition (American Society of Anesthesiologists (ASA) classification), neurological status (Frankel grade), and improvement after surgery, fusion length, operating time, estimated blood loss, and perioperative complications. Results: Preoperatively, the PS group consisted of one ASA-1 patient, eight ASA-2 patients, six ASA-3 patients, and one ASA-4 patient; by Frankel grade, there were 2 grade B patients, 13 grade C, 4 grade D, and 6 grade E patients. The O group had 2 ASA-1 patients, 13 ASA-2, 9 ASA-3, and 1 ASA-4 patients. Frankel grades in the O group reflected severe neurological deficits, with 3 grade C patients, 2 grade D, and 11 grade E (p ¼ 0.032) patients. The two groups had similar rates of neurological improvement (33.3% of PS and 40.0% of O patients; p ¼ 0.410) and mean fusion length (PS 5.1 + 0.8 segments; O 4.9 + 1.2). The mean operating time and estimated blood loss were 168.1 + 46.7 min and 133.9 + 116.5 g, respectively, in the PS group, and 224.6 + 49.8 min and 499.9 + 368.5 g in the O group. Three O-group patients died of hypovolemic shock, respiratory failure, and pneumonia, respectively, within a year of surgery. Conclusion: Conventional open posterior fixation and PPS fixation for DISH-related spinal fractures were similar in fusion length and neurological improvement. However, PPS fixation was less invasive and had lower complication rates.

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“…DISH-associated vertebral fracture is unstable like a long bone fracture and often leads to severe paralysis after displacement. Early surgical stabilization is recommended 1,2) ; however, 26.6% postoperative complications 2) , neurological deterioration 3) , and perioperative deaths [2][3][4][5][6] have been reported. Conservative treatment is selected in patients with surgical risk factors or delayed diagnosis 2) .…”

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A Case of Vertebral Fracture Associated with Diffuse Idiopathic Skeletal Hyperostosis Treated by a Successful Conservative Treatment

Saita

Monobe

Ogihara

et al. 2019

Spine Surg Relat Res

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Keywords:diffuse idiopathic skeletal hyperostosis, vertebral fracture, conservative treatment Spine Surg Relat Res 2019; 3(4): 401-403 dx.We present a case of vertebral fracture associated with diffuse idiopathic skeletal hyperostosis (DISH) treated by a successful conservative treatment. DISH-associated vertebral fracture is unstable like a long bone fracture and often leads to severe paralysis after displacement. Early surgical stabilization is recommended 1,2) ; however, 26.6% postoperative complications 2) , neurological deterioration 3) , and perioperative deaths 2-6) have been reported. Conservative treatment is selected in patients with surgical risk factors or delayed diagnosis 2) . However, detailed reports on conservative cases are lacking.A 63-year-old man experienced back pain after a fall. He had hypertension, diabetes, and hemodialysis for 3 years and had undergone coronary stent graft for angina pectoralis 1 year before. One month after the fall, he visited a clinic and was diagnosed with vertebral fracture, and posterior fusion surgery was recommended. However, he rejected surgery because he had not received any treatment for 1 month and experienced only slight back pain. Then, he visited our hospital.He could walk without aid or external fixation and showed no neurological deficit.Computed tomography (CT) 1 month after the fall revealed continuous ossification of the anterior longitudinal ligament (OALL) from T2 to L2, and it was broken at T7/ T8 ( Fig. 1-ab). On the right side, the fracture line ran through the T8 vertebral body horizontally via the T8 pedicle to the posterior wall of the lamina (Fig. 1-a). The T6-T8 spinous processes were fractured vertically ( Fig. 1-b). In the spinal canal, the yellow ligament ossified in the midposterior portion.It was diagnosed as DISH, not ankylosing spondylitis, as there was no history of low back pain and no inflammation finding in the blood examination and there was a large lumbar osteophyte. As there was no neurological deficit, he refused surgical treatment. Furthermore, he had many comorbidities; therefore, he was treated conservatively with thoracolumbar orthosis made with plastic and metal frame covering the chest to the iliac crest while performing standing activities about 4 to 12 hours per day. He came to our clinic every month for 5 months and after once for every 2 months, and CT evaluation was performed at 1, 2, 3, 5, 7, 11, 15 months after the injury, and plain X-ray was performed at 4, 9 months.Two months after the injury, back pain was reduced and he could recline on a tilted chairback. CT showed no fracture displacement. Three months after the injury, back pain while lying down resolved. Ventral callus formation ahead of OALL at T7/T8, sclerotic change in the T8 vertebral body, and callus formation around the spinous process were observed (Fig. 2-a). After 5 months, he experienced back pain only when lying on a hard floor. Ventral callus formation ahead of OALL had developed, and the fracture line in the posterior T8 vertebral body became...

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CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis

Cited by 38 publications

References 15 publications

Imaging of diffuse idiopathic skeletal hyperostosis (DISH)

Imaging of diffuse idiopathic skeletal hyperostosis (DISH)

Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation

A Case of Vertebral Fracture Associated with Diffuse Idiopathic Skeletal Hyperostosis Treated by a Successful Conservative Treatment

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