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- Title
CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis.
- Authors
Okada, Eijiro; Tsuji, Takashi; Shimizu, Kentaro; Kato, Masanori; Fukuda, Kentaro; Kaneko, Shinjiro; Ogawa, Jun; Watanabe, Kota; Ishii, Ken; Nakamura, Masaya; Matsumoto, Morio
- Abstract
<bold>Purpose: </bold>To clarify correlations between spinal fracture and delayed paralysis in patients with diffuse idiopathic skeletal hyperostosis (DISH) using computed tomography (CT) with multiplanar reformatting (CT-MPR). DISH increases susceptibility to unstable spinal fractures, leading to neurological deterioration. The pathomechanism of the neurological injury is unclear.<bold>Methods: </bold>This multicenter retrospective study included 42 DISH patients (32 male; 10 female) treated for 45 spinal fractures during a 5-year period. The mean age at the time of injury was 77.1 ± 10.1 years. The cause of injury, delay in diagnosis, fracture location, and neurological status were recorded, and anterior- and posterior-column fractures, a fracture displacement over 3 mm, and posterior-column ankylosis were assessed using CT-MPR.<bold>Results: </bold>Most fractures (73.8%) resulted from trivial trauma, such as falling from a standing or sitting position. Diagnosis was delayed in 47.6% of the patients, primarily due to delays in seeking medical attention (65.0%). Although 78.6% of the patients were neurologically intact at the time of injury, 54.8% developed paralysis, defined by a change in one or more Frankel-score levels during short-term follow-up. Of the fractures, 39.1% were in the vertebral body, and 60.9% were at the disc level. Fractures with posterior-column ankylosis were significantly associated with delayed paralysis.<bold>Conclusions: </bold>CT-MPR was useful for evaluating spinal fractures and determining treatment in patients with DISH. Fractures associated with posterior-column ankylosis resulted in unstable three-column injuries that led to delayed neurological deterioration. Early surgical stabilization of such fractures is recommended to avoid delayed paralysis.
- Subjects
JAPAN; SPINAL cord injuries; EXOSTOSIS; COMPUTED tomography; DISEASE susceptibility; DIAGNOSIS; THERAPEUTICS; SPINAL osteophytosis complications; THORACIC vertebrae injuries; AGE distribution; FRACTURE fixation; BONE fractures; LONGITUDINAL method; MAGNETIC resonance imaging; ORTHOPEDIC implants; PROGNOSIS; RISK assessment; SEX distribution; SPINAL osteophytosis; SPINAL injuries; THORACIC vertebrae; RETROSPECTIVE studies; SEVERITY of illness index; TRAUMA severity indices; FRACTURE healing
- Publication
Journal of Orthopaedic Science, 2017, Vol 22, Issue 1, p3
- ISSN
0949-2658
- Publication type
journal article
- DOI
10.1016/j.jos.2016.09.011