Spine Fractures of Patients with Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis: Fracture Severity and Injury-Related Mortality at a Level I Trauma Center

Abstract

Retrospective review of prospectively collected cohort.Purpose: To identify differences in treatment and mortality of spine fractures in patients with ankylosing conditions of the spine. Overview of Literature: Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are the two most common etiologies of ankylosing spinal disorder (ASD). However, studies on the treatment and outcomes of spine fractures in AS and DISH patients remain few. Methods: Patients presenting with a spine fracture were diagnosed with AS or DISH at a single tertiary care center between 2010 and 2019. We excluded those who lacked cross-sectional imaging or fractures occurring at spinal segments affected by ankylosis, as well as polytraumatized patients. Patient demographics, injury mechanism, fracture level, neurologic status, treatment, and 1-year mortality were recorded. Computed tomography imaging was reviewed by two independent readers and graded according to the indicated AO Spine Injury Classification System. Differences in fracture severity, treatment method, and mortality were examined using Student t-tests, chi-square tests, and two-proportion Z-tests with significance set to p<0.05. Results: We identified 167 patients with spine fracture diagnosed with AS or DISH. Patients with AS had more severe fractures and more commonly had surgery than patients with DISH (p<0.001). Despite these differences, 1-year mortality did not significantly differ between AS and DISH patients (p=0.14). Conclusions: Although patients with AS suffered more severe fractures compared to DISH and more frequently underwent surgery for these injuries, outcomes and 1-year mortality did not differ significantly between the two groups. For patients with ASDs and fractures, outcomes appear similar regardless of treatment modality. Consequently, there may be an opportunity for critical reappraisal of operative indications in ASD and a larger role for nonoperative management in these challenging patients.

Significant Reduction in Bone Density as Measured by Hounsfield Units in Patients with Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis

“…Stresses were also greatest in the anterior column, with a progressive decline in the middle and posterior columns. This concords with prior examinations of fracture pattern in DISH, which have shown disproportionate involvement of the anterior and middle columns in DISH fractures [ 41 , 43 , 44 ]. It is noted that most fractures occur between regions of hypertrophic ossification and at junctional regions where autofused segments abut mobile segments, likely due to the generation of stress risers at these points.…”

“…Subanalysis demonstrated severely reduced mid-fused segment HUs in AS (74) compared to DISH patients (123), which may help to explain the more severe fractures noted in patients with AS as compared to DISH. A recent study by Chen and colleagues examined 137 patients with AS or DISH presenting with trauma, and they found that AS patients suffered more severe fractures compared to DISH and more frequently underwent surgery for these injuries [ 44 ].…”

Educational effects of and satisfaction with mixed-reality-based major trauma care simulator: A preliminary evaluation

“…Trauma is one of the leading causes of death among young people worldwide. [4][5][6][7] Among trauma patients, 50% of deaths occur within the first hour and 30% within a few hours. [8] High proficiencies are required for rapid treatment to reduce preventable mortality.…”