Posterior spinal fixation using penetrating endplate screws in patients with diffuse idiopathic skeletal hyperostosis–related thoracolumbar fractures

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  • 1 Orthopedic Surgery, Sanmu Medical Center, Chiba, Japan; and
  • | 2 Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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OBJECTIVE

Diffuse idiopathic skeletal hyperostosis (DISH)–related vertebral fractures essentially require operative treatment due to severe fracture site instability and high potential risk of posttraumatic neurological deficit. However, the optimal surgical procedure remains unclear. The purpose of this study was to assess the efficacy of posterior spinal fixation with penetrating endplate screws (PESs) for DISH-related thoracolumbar fractures.

METHODS

The authors conducted a retrospective, single-center, observational study. They included data from 26 consecutive patients with DISH-related thoracolumbar fractures who were treated with posterior spinal fixation using either conventional pedicle screws (PS group, n = 8) or a combined PES technique (PES group, n = 18) between 2013 and 2019. Age, sex, BMI, bone mineral density, fracture level, use of antithrombotic drug, blood loss, operation time, fixation range, perioperative American Spinal Injury Association Impairment Scale score, implant failure, revision surgery, complications, and mortality were compared. The authors also evaluated screw loosening and bone healing on radiographs and CT scans.

RESULTS

More patients had vertebral fractures in the lumbar spine in the PS group than in the PES group (3 vs 0; p = 0.019). Patients in the PES group had less blood loss (63 vs 173 ml; p = 0.048) and shorter range of fixation (5 vs 5.5 levels; p = 0.041). The screw loosening rate was significantly lower in the PES group than in the PS group (3% vs 49%; p < 0.001).

CONCLUSIONS

Posterior spinal fixation using a PES technique may be an ideal surgical procedure for thoracolumbar fractures with DISH, providing more rigid and less invasive fixation than PS.

ABBREVIATIONS

ASIA = American Spinal Injury Association; BMD = bone mineral density; DISH = diffuse idiopathic skeletal hyperostosis; PES = penetrating endplate screw; PPS = percutaneous pedicle screw; PS = pedicle screw.

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Contributor Notes

Correspondence Takahisa Hishiya: Graduate School of Medicine, Chiba University, Chiba, Japan. tk.hishiya@chiba-u.jp.

INCLUDE WHEN CITING Published online April 9, 2021; DOI: 10.3171/2020.10.SPINE201387.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. Ann Rheum Dis. 1950;9(4):321330.

  • 2

    Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier’s disease with extraspinal manifestations. Radiology. 1975;115(3):513524.

    • Search Google Scholar
    • Export Citation
  • 3

    Mader R, Lavi I. Diabetes mellitus and hypertension as risk factors for early diffuse idiopathic skeletal hyperostosis (DISH). Osteoarthritis Cartilage. 2009;17(6):825828.

    • Search Google Scholar
    • Export Citation
  • 4

    Murakami Y, Mashima N, Morino T, et al. . Association between vertebral fracture and diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976). 2019;44(18):E1068E1074.

    • Search Google Scholar
    • Export Citation
  • 5

    Kagotani R, Yoshida M, Muraki S, et al. . Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study. J Bone Miner Metab. 2015;33(2):221229.

    • Search Google Scholar
    • Export Citation
  • 6

    Okada E, Yoshii T, Yamada T, et al. . Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: a nationwide multi-institution survey. J Orthop Sci. 2019;24(4):601606.

    • Search Google Scholar
    • Export Citation
  • 7

    Hiyama A, Katoh H, Sakai D, et al. . Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects. BMC Musculoskelet Disord. 2018;19(1):178.

    • Search Google Scholar
    • Export Citation
  • 8

    Hirasawa A, Wakao N, Kamiya M, et al. . The prevalence of diffuse idiopathic skeletal hyperostosis in Japan—the first report of measurement by CT and review of the literature. J Orthop Sci. 2016;21(3):287290.

    • Search Google Scholar
    • Export Citation
  • 9

    Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009;18(2):145156.

    • Search Google Scholar
    • Export Citation
  • 10

    Caron T, Bransford R, Nguyen Q, et al. . Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010;35(11):E458E464.

    • Search Google Scholar
    • Export Citation
  • 11

    Westerveld LA, van Bemmel JC, Dhert WJA, et al. . Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 2014;14(5):729740.

    • Search Google Scholar
    • Export Citation
  • 12

    Okada E, Shimizu K, Kato M, et al. . Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: Clinical characteristics by fracture level. J Orthop Sci. 2019;24(3):393399.

    • Search Google Scholar
    • Export Citation
  • 13

    Vaccaro AR, Schroeder GD, Kepler CK, et al. . The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spine J. 2016;25(4):10871094.

    • Search Google Scholar
    • Export Citation
  • 14

    Abdu WA, Wilber RG, Emery SE. Pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis. A new technique for stabilization. Spine (Phila Pa 1976). 1994;19(6):710715.

    • Search Google Scholar
    • Export Citation
  • 15

    Matsukawa K, Yato Y, Kato T, et al. . Cortical bone trajectory for lumbosacral fixation: penetrating S-1 endplate screw technique: technical note. J Neurosurg Spine. 2014;21(2):203209.

    • Search Google Scholar
    • Export Citation
  • 16

    Nottmeier EW, Pirris SM. Placement of thoracic transvertebral pedicle screws using 3D image guidance. J Neurosurg Spine. 2013;18(5):479483.

    • Search Google Scholar
    • Export Citation
  • 17

    Minamide A, Akamaru T, Yoon ST, et al. . Transdiscal L5-S1 screws for the fixation of isthmic spondylolisthesis: a biomechanical evaluation. J Spinal Disord Tech. 2003;16(2):144149.

    • Search Google Scholar
    • Export Citation
  • 18

    Collados-Maestre I, Lizaur-Utrilla A, Bas-Hermida T, et al. . Transdiscal screw versus pedicle screw fixation for high-grade L5-S1 isthmic spondylolisthesis in patients younger than 60 years: a case-control study. Eur Spine J. 2016;25(6):18061812.

    • Search Google Scholar
    • Export Citation
  • 19

    Rodriguez-Martinez NG, Savardekar A, Nottmeier EW, et al. . Biomechanics of transvertebral screw fixation in the thoracic spine: an in vitro study. J Neurosurg Spine. 2016;25(2):187192.

    • Search Google Scholar
    • Export Citation
  • 20

    Moussallem CD, McCutcheon BA, Clarke MJ, et al. . Perioperative complications in open versus percutaneous treatment of spinal fractures in patients with an ankylosed spine. J Clin Neurosci. 2016;30:88-92.

    • Search Google Scholar
    • Export Citation
  • 21

    Sedney CL, Daffner SD, Obafemi-Afolabi A, et al. . A comparison of open and percutaneous techniques in the operative fixation of spinal fractures associated with ankylosing spinal disorders. Int J Spine Surg. 2016;10:23.

    • Search Google Scholar
    • Export Citation
  • 22

    Krüger A, Frink M, Oberkircher L, et al. . Percutaneous dorsal instrumentation for thoracolumbar extension-distraction fractures in patients with ankylosing spinal disorders: a case series. Spine J. 2014;14(12):28972904.

    • Search Google Scholar
    • Export Citation
  • 23

    Wu X, Shi J, Wu J, et al. . Pedicle screw loosening: the value of radiological imagings and the identification of risk factors assessed by extraction torque during screw removal surgery. J Orthop Surg Res. 2019;14(1):6.

    • Search Google Scholar
    • Export Citation
  • 24

    Ohtori S, Inoue G, Orita S, et al. . Comparison of teriparatide and bisphosphonate treatment to reduce pedicle screw loosening after lumbar spinal fusion surgery in postmenopausal women with osteoporosis from a bone quality perspective. Spine (Phila Pa 1976). 2013;38(8):E487E492.

    • Search Google Scholar
    • Export Citation
  • 25

    Kim JB, Park SW, Lee YS, et al. . The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc. 2015;58(4):357362.

    • Search Google Scholar
    • Export Citation
  • 26

    Hiyama A, Sakai D, Sato M, Watanabe M. The analysis of percutaneous pedicle screw technique with guide wire-less in lateral decubitus position following extreme lateral interbody fusion. J Orthop Surg Res. 2019;14(1):304.

    • Search Google Scholar
    • Export Citation

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