Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey

Eijiro Okada, Toshitaka Yoshii, Tsuyoshi Yamada, Kei Watanabe, Keiichi Katsumi, Akihiko Hiyama, Masahiko Watanabe, 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 Mori & 6 others Mikito Tsushima, Hirosuke Nishimura, Takashi Tsuji, Atsushi Okawa, Morio Matsumoto, Kota Watanabe

Research output: Contribution to journalArticle

Abstract

Background: Diffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH. Methods: Patients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years). Results: The major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically. Conclusions: Minor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.

Original languageEnglish
Pages (from-to)601-606
Number of pages6
JournalJournal of Orthopaedic Science
Volume24
Issue number4
DOIs
Publication statusPublished - 01-07-2019

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Diffuse Idiopathic Skeletal Hyperostosis
Spinal Fractures
Wounds and Injuries
Ossification of Posterior Longitudinal Ligament
Delayed Diagnosis
Posture
Spine
Surveys and Questionnaires
Osteogenesis
Multicenter Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Okada, Eijiro ; Yoshii, Toshitaka ; Yamada, Tsuyoshi ; Watanabe, Kei ; Katsumi, Keiichi ; Hiyama, Akihiko ; Watanabe, Masahiko ; Nakagawa, Yukihiro ; Okada, Motohiro ; Endo, Teruaki ; Shiraishi, Yasuyuki ; Takeuchi, Kazuhiro ; Matsunaga, Shunji ; Maruo, Keishi ; Sakai, Kenichiro ; Kobayashi, Sho ; Ohba, Tetsuro ; Wada, Kanichiro ; Ohya, Junichi ; Mori, Kanji ; Tsushima, Mikito ; Nishimura, Hirosuke ; Tsuji, Takashi ; Okawa, Atsushi ; Matsumoto, Morio ; Watanabe, Kota. / Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey. In: Journal of Orthopaedic Science. 2019 ; Vol. 24, No. 4. pp. 601-606.
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title = "Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey",
abstract = "Background: Diffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH. Methods: Patients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years). Results: The major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2{\%}). Diagnosis of the fracture was delayed in 115 patients (40.4{\%}). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5{\%}). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6{\%}) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8{\%}). Neurological improvement was seen in 20.0{\%} of the conservatively treated patients, and in 47.0{\%} of the patients treated surgically. Conclusions: Minor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.",
author = "Eijiro Okada and Toshitaka Yoshii and Tsuyoshi Yamada and Kei Watanabe and Keiichi Katsumi and Akihiko Hiyama and Masahiko Watanabe and Yukihiro Nakagawa and Motohiro Okada and Teruaki Endo and Yasuyuki Shiraishi and Kazuhiro Takeuchi and Shunji Matsunaga and Keishi Maruo and Kenichiro Sakai and Sho Kobayashi and Tetsuro Ohba and Kanichiro Wada and Junichi Ohya and Kanji Mori and Mikito Tsushima and Hirosuke Nishimura and Takashi Tsuji and Atsushi Okawa and Morio Matsumoto and Kota Watanabe",
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Okada, E, Yoshii, T, Yamada, T, Watanabe, K, Katsumi, K, Hiyama, A, Watanabe, M, Nakagawa, Y, Okada, M, Endo, T, Shiraishi, Y, Takeuchi, K, Matsunaga, S, Maruo, K, Sakai, K, Kobayashi, S, Ohba, T, Wada, K, Ohya, J, Mori, K, Tsushima, M, Nishimura, H, Tsuji, T, Okawa, A, Matsumoto, M & Watanabe, K 2019, 'Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey', Journal of Orthopaedic Science, vol. 24, no. 4, pp. 601-606. https://doi.org/10.1016/j.jos.2018.12.017

Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey. / Okada, Eijiro; Yoshii, Toshitaka; Yamada, Tsuyoshi; Watanabe, Kei; Katsumi, Keiichi; Hiyama, Akihiko; Watanabe, Masahiko; Nakagawa, Yukihiro; Okada, Motohiro; Endo, Teruaki; Shiraishi, Yasuyuki; Takeuchi, Kazuhiro; Matsunaga, Shunji; Maruo, Keishi; Sakai, Kenichiro; Kobayashi, Sho; Ohba, Tetsuro; Wada, Kanichiro; Ohya, Junichi; Mori, Kanji; Tsushima, Mikito; Nishimura, Hirosuke; Tsuji, Takashi; Okawa, Atsushi; Matsumoto, Morio; Watanabe, Kota.

In: Journal of Orthopaedic Science, Vol. 24, No. 4, 01.07.2019, p. 601-606.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey

AU - Okada, Eijiro

AU - Yoshii, Toshitaka

AU - Yamada, Tsuyoshi

AU - Watanabe, Kei

AU - Katsumi, Keiichi

AU - Hiyama, Akihiko

AU - Watanabe, Masahiko

AU - Nakagawa, Yukihiro

AU - Okada, Motohiro

AU - Endo, Teruaki

AU - Shiraishi, Yasuyuki

AU - Takeuchi, Kazuhiro

AU - Matsunaga, Shunji

AU - Maruo, Keishi

AU - Sakai, Kenichiro

AU - Kobayashi, Sho

AU - Ohba, Tetsuro

AU - Wada, Kanichiro

AU - Ohya, Junichi

AU - Mori, Kanji

AU - Tsushima, Mikito

AU - Nishimura, Hirosuke

AU - Tsuji, Takashi

AU - Okawa, Atsushi

AU - Matsumoto, Morio

AU - Watanabe, Kota

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Diffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH. Methods: Patients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years). Results: The major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically. Conclusions: Minor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.

AB - Background: Diffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH. Methods: Patients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years). Results: The major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically. Conclusions: Minor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.

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U2 - 10.1016/j.jos.2018.12.017

DO - 10.1016/j.jos.2018.12.017

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SP - 601

EP - 606

JO - Journal of Orthopaedic Science

JF - Journal of Orthopaedic Science

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