Fractures in Spinal Ankylosing Disorders: A Narrative Review of Disease and Injury Types, Treatment Techniques, and Outcomes

Rustagi, Tarush; Drazin, Doniel; Öner, Cumhur; York, Jonathan; Schroeder, Gregory D.; Vaccaro, Alexander R.; Oskouian, Rod J.; Chapman, Jens R.

doi:10.1097/bot.0000000000000953

Cited by 124 publications

(119 citation statements)

References 98 publications

Supporting

Mentioning

115

Contrasting

Unclassified

Order By: Relevance

“…In terms of surgical treatments for lumbar spinal disorders accompanying DISH, Otsuki et al reported shortsegment lumbar interbody fusion as a factor in delayed pseudarthrosis and adjacent segment disease (ASD) [20]. Further, numerous studies have reported that surgical treatment for traumatic spine fracture accompanying DISH often requires multi-level fusion to avoid postoperative ASD [21][22][23]. To maintain postoperative sagittal alignment, pelvic screw insertion, as a strong anchor of spinal fixation, became an indispensable technique not only in patients with DISH, but also in many clinical scenarios such as adult degenerative scoliosis, flat-back syndrome and kyphosis [24].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis

Yahara

Yasuda

Kawaguchi

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of vertebral bodies and peripheral entheses. However, variations in sacroiliac (SI) joint change in patients with DISH have not been fully clarified. The purpose of this study was to evaluate SI joint variation in patients with DISH in comparison with a non-DISH population. Methods: A total of 342 SI joints in 171 patients (DISH+, n = 86; DISH-, n = 85) who had undergone lumbar spine surgery were analyzed by computed tomography examination. SI joint variations were classified into four types: Type 1, normal or tiny peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophytes formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. The type of bridging osteophyte in SI joints and the prevalence of ossification in each spinal segment from C1 to SI joint were also examined. Results: The most common SI joint variation in the DISH+ group was bony fusion (Type 4), with 71.6% exhibiting anterior paraarticular bridging. On the other hand, SI joint vacuum phenomenon (Type 3) was the most frequent change (57.1%) in the DISH-group. The middle to lower thoracic spine and SI joints were highly affected in DISH and caused bony ankylosis. Conclusions: Anterior paraarticular bridging was the most common type of SI joint change in patients with DISH who underwent lumbar spine surgery. The present results regarding variations of SI joint changes in DISH should help understand the etiology of DISH.

show abstract

Section: Discussionmentioning

confidence: 99%

“…This study was approved by the ethics committee at Toyama University Hospital (Clinical research number [21][22]. Patients provided written consent for participation in this analysis.…”

Section: Authors' Contributionsmentioning

confidence: 99%

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis

Yahara

Yasuda

Kawaguchi

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…That is, an ankylosed spine tends to fracture as result of minor injuries such as falling because of stress concentration. Such fractures can cause reverse chance fractures that can lead to spinal paralyses, and are often resistant to conservative treatment [ 1 – 3 ]. Like other conditions with ligament ossification, DISH is thought to result from a multifactorial process whose etiology is not easily identified.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects

Hiyama

Katoh

Sakai

et al. 2018

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundComputed tomography (CT) analyses have reported that the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in Japan is 8.7–27.1%. However, these data were obtained using chest-abdominal CT, and no evaluations of sagittal, coronal, and axial images using whole-spine CT have been reported. The aim of this study was to investigate the prevalence and characteristic of DISH by whole spinal CT.MethodsParticipants were patients who had experienced trauma who had undergone whole-spine CT scanning based on the initial clinical practice guidelines for trauma in our institute from April 2015 to February 2018. The subjects were > 20 years old and 1479 were included in the analysis. The presence and distribution of DISH and clinical parameters such as age and sex were reviewed retrospectively according to the location of DISH.ResultsThe overall prevalence of DISH was 19.5% (n = 289). Subjects with DISH were older than those without. DISH was located in the thoracic spine in 65.1% and thoracolumbar spine in 24.2% of patients. More than 80% of ligamentous ossifications associated with DISH occurred at T8 (n = 255, 88%), T9 (n = 262, 91%), and T10 (n = 247, 85%). Most of the ossification occurred to the right anterior of the vertebral body, and there were few ossifications in the areas in contact with the artery and vein.ConclusionsThe prevalence of DISH based on whole-spine CT was 19.5%. Ossification was noted more often at T8, T9, and T10, and to the right anterior of the vertebral body. It is for the first time report that we have studied the location of ossification in detail using the axial images of whole spine CT. We hope this study will enhance the understanding of the characteristics of DISH.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2108-5) contains supplementary material, which is available to authorized users.

show abstract

“…We found 2 case reports of iatrogenic fracture in patients with AS during surgery [ 9 ]. Compared with the normal population with minor trauma, patients with AS are at a higher risk for spinal fracture [ 10 - 14 ], likely because of the higher incidence of osteoporosis or osteopenia [ 14 - 16 ]. In addition, a rigid spine is unable to distribute the stress to the other segments.…”

Section: Discussionmentioning

confidence: 99%

Chin on Chest Deformity Caused by Upper Cervical Kyphosis Associated With Ankylosing Spondylitis: A Case Report

Maruiwa

Watanabe²,

Suzuki³

et al. 2020

Neurospine

View full text Add to dashboard Cite

Chin on chest deformity caused by upper cervical kyphosis associated with ankylosing spondylitis is rare. A 66-year-old woman presented at our institute with chief complaints of difficulty in horizontal gaze and opening her mouth. Cervical radiographs showed a C0-2 angle of 1° on flexion and 7° on extension, and her chin-brow vertical angle was 49°. We planned fixation surgery at C0-5 posteriorly to prevent the progression of kyphosis, with slight correction of the kyphosis at C0-2. The correction was performed by pushing down the over lordotically contoured titanium rods connected to an occipital plate onto the C3-5 lateral mass screws, just like cantilever technique. No palpable cracking or loss of resistance was noticed during the correction. However, intraoperative radiographs revealed apparent anterior separation of the vertebral bodies between C3 and C4. Postoperative computed tomography images at the C3/4 level suggested hemorrhage from the fracture site. Tracheostomy was performed because of massive edema around the pharynx. To secure solid bone fusion, staged surgery to extend the fusion to T3 and to graft an additional iliac bone was performed. Fortunately, the C2-7 angle was corrected to 40°, and her chin-brow vertical angle was restored to 17° without any catastrophic complications. Although the patient finally obtained an ideal sagittal alignment, the surgeon should be aware that the technique had a higher perioperative risk for iatrogenic fracture, resulting in neurological and vascular injuries.

show abstract

Fractures in Spinal Ankylosing Disorders: A Narrative Review of Disease and Injury Types, Treatment Techniques, and Outcomes

Cited by 124 publications

References 98 publications

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis

Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects

Chin on Chest Deformity Caused by Upper Cervical Kyphosis Associated With Ankylosing Spondylitis: A Case Report

Contact Info

Product

Resources

About