TY - JOUR
T1 - Spinal fractures in diffuse idiopathic skeletal hyperostosis
T2 - Advantages of percutaneous pedicle screw fixation
AU - Okada, Eijiro
AU - Shiono, Yuta
AU - Nishida, Mitsuhiro
AU - Mima, Yuichiro
AU - Funao, Haruki
AU - Shimizu, Kentaro
AU - Kato, Masanori
AU - Fukuda, Kentaro
AU - Fujita, Nobuyuki
AU - Yagi, Mitsuru
AU - Nagoshi, Narihito
AU - Tsuji, Osahiko
AU - Ishii, Ken
AU - Nakamura, Masaya
AU - Matsumoto, Morio
AU - Watanabe, Kota
N1 - Funding Information:
The authors thank Kazuhiro Chiba (Department of Orthopaedic Surgery, National Defense Medical College), Yuichiro Takahashi (Department of Orthopaedic Surgery, Sano General Hospital), Michihiro Kamata (Department of Orthopaedic Surgery, Keiyu Hospital), Tetsuya Kuramoto (Department of Orthopaedic Surgery, Saitama City Hospital), Katsuki Kono (Department of Orthopaedic Surgery, Kono Orthopaedic Surgery Clinic), Masayuki Ishikawa (Department of Orthopaedic Surgery, International University of Health and Welfare), Hikata Tomohiro (Department of Orthopaedic Surgery, Kitasato University, Kitasato Institute Hospital), Ken Ninomiya and Satoshi Suzuki (Department of Orthopaedic Surgery, Tokyo Dental College, Ichikawa General Hospital), Kunimasa Okuyama (Orthopaedic Surgery, Sizuoka City Shimizu Hospital), Kazuya Kitamura (Department of Orthopaedic Surgery, Saiseikai Yokohamahi Tobu Hospital), Kenya Nojiri (Department of Orthopaedic Surgery, Isehara Kyodo Hospital), Yohei Takahashi (Department of Orthopaedic Surgery, Shizuoka Red Cross Hospital), Yosuke Horiuchi (Japan Community Health care Organization, Saitama Medical Center), Tomoki Ieda (Department of Orthopaedic Surgery, Ashikaga Red Cross Hospital), Seiji Ueda (Department of Orthopaedic Surgery, Kawasaki municipal Hospital), Kiyoshi Inoue (Department of Orthopaedic Surgery, Saiseikai Mukoujima Hospital), Daisuke Nakashima and Akio Iwanami (Department of Orthopaedic Surgery, Keio university), all doctors participating in the Keio Spine Research Group for their help with this study, and Yuji Nishiwaki (Department of Environmental and Occupational Health, School of Medicine, Toho University) and Midori Morishita, Masaki Tezuka, and Shigeru Yanagimoto (Department of Orthopaedic Surgery, Saiseikai Central Hospital) for their kind help and comments on this study. The author(s) received no financial support for the research, authorship, and/or publication of this article.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Purpose: 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 = 0.032) patients. The two groups had similar rates of neurological improvement (33.3% of PS and 40.0% of O patients; p = 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.
AB - Purpose: 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 = 0.032) patients. The two groups had similar rates of neurological improvement (33.3% of PS and 40.0% of O patients; p = 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.
KW - ankylosing spinal disorder
KW - diffuse idiopathic skeletal hyperostosis
KW - flowing ossification
KW - percutaneous pedicle screw fixation
KW - spinal fracture
KW - surgical outcomes
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U2 - 10.1177/2309499019843407
DO - 10.1177/2309499019843407
M3 - Article
C2 - 31079563
AN - SCOPUS:85066060691
VL - 27
JO - Journal of the Western Pacific Orthopaedic Association
JF - Journal of the Western Pacific Orthopaedic Association
SN - 1022-5536
IS - 2
ER -