Vertebral pseudoarthrosis associated with diffuse idiopathic skeletal hyperostosis

Abstract

Diffuse idiopathic skeletal hyperostosis is an ossifying diathesis that commonly affects the vertebral skeleton. Spinal ankylosis can occur, predisposing the spine to abnormal stresses and fracture. Fracture through an ankylosed segment with continued motion at the site of fracture can result in pseudoarthrosis. Pseudoarthrosis can also develop at the junction of the fused and mobile spine secondary to chronic abnormal stresses. This complication is manifest radiographically by single-level intervertebral disc space destruction, vertebral endplate erosions, marked vertebral sclerosis, and large osteophytes. The radiographic manifestations can mimic infective spondylitis or neuropathic changes.

Spontaneous Symptomatic Pseudoarthrosis at the T11–T12 Intervertebral Space With Diffuse Idiopathic Skeletal Hyperostosis: A Case Report

“…In a literature search, we found five cases of spontaneous symptomatic intervertebral pseudoarthrosis associated with DISH. 13,18 In three cases, the pseudoarthrosis was located in the cervical area. 18 Quagliano et al reported two cases of spontaneous pseudoarthrosis with DISH in which the patients had pseudoarthrosis in the thoracolumbar region, one at the T9 -T10 level triggered by trivial trauma and one at L1-L2 with no history of trauma; both patients had back pain and were treated conservatively.…”

“…18 Quagliano et al reported two cases of spontaneous pseudoarthrosis with DISH in which the patients had pseudoarthrosis in the thoracolumbar region, one at the T9 -T10 level triggered by trivial trauma and one at L1-L2 with no history of trauma; both patients had back pain and were treated conservatively. 13 These authors suggested that there were two types of spinal pseudoarthrosis with DISH: pseudoarthrosis after acute fracture and pseudoarthrosis as a result of cumulative stress at the junction of mobile and immobile vertebral segments. 13 Our case presumably falls into the latter category.…”

“…13 These authors suggested that there were two types of spinal pseudoarthrosis with DISH: pseudoarthrosis after acute fracture and pseudoarthrosis as a result of cumulative stress at the junction of mobile and immobile vertebral segments. 13 Our case presumably falls into the latter category. Flexion and extension had transmitted mechanical stress to the thoracolumbar junction in daily activity at the early stage of DISH ossification, and this stress eventually led to the formation of a pseudoarthrosis at the T11-T12 intervertebral space.…”

“…12,17 Pseudoarthrosis of the thoracolumbar spine at the vertebral interspace in AS, 7,15 including spontaneous pseudoarthrosis, 1,3 has been reported by several authors. However, in patients with DISH, pseudoarthrosis at a vertebral interspace is very rare, 13,18 partly because the vertebral body is frequently fractured.…”

“…3,7,15 However, in patients with DISH, pseudoarthrosis at a vertebral interspace combined with painful motion at the site of pseudoarthrosis and the absence of a history of trauma is very rare. 13 We report a case of DISH with spontaneous symptomatic pseudoarthrosis at only one intervertebral space (T11-T12). The patient was treated successfully by both posterior spinal instrumentation and anterior bone grafting.…”