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Open AccessArticle

A Comparison of Cervical and Thoracolumbar Fractures Associated with Diffuse Idiopathic Skeletal Hyperostosis—A Nationwide Multicenter Study

Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa 259-1193, Japan
Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo 113-8519, Japan
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Department of Orthopaedic Surgery, Niigata University, Niigata 951-8510, Japan
Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, Wakayama 649-7113, Japan
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama 641-8509, Japan
Department of Orthopaedic Surgery, Jichi Medical University, Tochigi 329-0498, Japan
Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan
Department of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima 892-8502, Japan
Department of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo 663-8501, Japan
Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama 332-8558, Japan
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka 432-8580, Japan
Department of Orthopaedic Surgery, Yamanashi University, Yamanashi 409-3898, Japan
Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan
Department of Orthopaedic Surgery, The University of Tokyo, Tokyo 113-8655, Japan
Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga 520-2192, Japan
Department of Orthopaedic Surgery, Chubu Rosai Hospital, Aichi 455-8530, Japan
Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo 160-8402, Japan
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(1), 208; (registering DOI)
Received: 14 December 2019 / Revised: 5 January 2020 / Accepted: 7 January 2020 / Published: 12 January 2020
(This article belongs to the Section Orthopedics)
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. View Full-Text
Keywords: diffuse idiopathic hyperostosis; spine trauma; ankylosis; trauma diffuse idiopathic hyperostosis; spine trauma; ankylosis; trauma
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Katoh, H.; Okada, E.; Yoshii, T.; Yamada, T.; Watanabe, K.; Katsumi, K.; Hiyama, A.; 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.; Watanabe, K.; Matsumoto, M.; Okawa, A.; Watanabe, M. A Comparison of Cervical and Thoracolumbar Fractures Associated with Diffuse Idiopathic Skeletal Hyperostosis—A Nationwide Multicenter Study. J. Clin. Med. 2020, 9, 208.

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