A comparison of cervical and thoracolumbar fractures associated with diffuse idiopathic skeletal hyperostosis—A nationwide multicenter study

Hiroyuki Katoh, Eijiro Okada, Toshitaka Yoshii, Tsuyoshi Yamada, Kei Watanabe, Keiichi Katsumi, Akihiko Hiyama, Yukihiro Nakagawa, Motohiro Okada, Teruaki Endo, Yasuyuki Shiraishi, Kazuhiro Takeuchi, Shunji Matsunaga, Keishi Maruo, Kenichiro Sakai, Sho Kobayashi, Tetsuro Ohba, Kanichiro Wada, Junichi Ohya, Kanji MoriMikito Tsushima, Hirosuke Nishimura, Takashi Tsuji, Kota Watanabe, Morio Matsumoto, Atsushi Okawa, Masahiko Watanabe

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

In diffuse idiopathic hyperostosis (DISH), the ankylosed spine becomes susceptible to spinal fractures and spinal cord injuries due to the long lever arms of the fractured segments that make the fracture extremely unstable. The aim of this retrospective multicenter study was to examine the differences in DISH-affected spine fractures according to fracture level. The data of 285 cases with fractures of DISH-ankylosed segments diagnosed through computed tomography (CT) imaging were studied and the characteristics of 84 cases with cervical fractures were compared to 201 cases with thoracolumbar fractures. Examination of the CT images revealed that cervical fracture cases were associated with ossification of the posterior longitudinal ligament and had fractures at the intervertebral disc level, while thoracolumbar fracture cases were associated with ankylosing of the posterior elements and had fractures at the vertebral body. Neurologically, cervical fracture cases had a higher ratio of spinal cord injury leading to higher mortality, while thoracolumbar fracture cases had lower rates of initial spinal cord injury. However, a subset of thoracolumbar fracture cases suffered from a delay in diagnosis that led to higher rates of delayed neurological deterioration. Some of these thoracolumbar fracture cases had no apparent injury episode but experienced severe neurological deterioration. The information provided by this study will hopefully aid in the education of patients with DISH and raise the awareness of clinicians to potential pitfalls in the assessment of DISH trauma patients.

Original languageEnglish
Article number208
JournalJournal of Clinical Medicine
Volume9
Issue number1
DOIs
Publication statusPublished - 2020 Jan

Keywords

  • Ankylosis
  • Diffuse idiopathic hyperostosis
  • Spine trauma
  • Trauma

ASJC Scopus subject areas

  • Medicine(all)

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