Outcomes following conservative treatment of extension fractures in the setting of diffuse idiopathic skeletal hyperostosis: is external orthosis alone a reasonable option?

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  • 1 Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
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OBJECTIVE

Extension fractures in the setting of diffuse idiopathic skeletal hyperostosis (DISH) represent highly unstable injuries. As a result, these fractures are most frequently treated with immediate surgical fixation to limit any potential risk of associated neurological injury. Although this represents the standard of care, patients with significant comorbidities, advanced age, or medical instability may not be surgical candidates. In this paper, the authors evaluated a series of patients with extension DISH fractures who were treated with orthosis alone and evaluated their outcomes.

METHODS

A retrospective review from 2015 to 2022 was conducted at a large level 1 trauma center. Patients with extension-type DISH fractures without neurological deficits were identified. All patients were treated conservatively with orthosis alone. Baseline patient characteristics and adverse outcomes are reported.

RESULTS

Twenty-seven patients were identified as presenting with extension fractures associated with DISH without neurological deficit. Of these, 22 patients had complete follow-up on final chart review. Of these 22 patients, 21 (95.5%) were treated successfully with external orthosis. One patient (4.5%) who was noncompliant with the brace had an acute spinal cord injury 1 month after presentation, requiring immediate surgical fixation and decompression. No other complications, including skin breakdown or pressure ulcers related to bracing, were reported.

CONCLUSIONS

Treatment of extension-type DISH fractures may be a reasonable option for patients who are not candidates for safe surgical intervention; however, a risk of neurological injury secondary to delayed instability remains, particularly if patients are noncompliant with the bracing regimen. This risk should be balanced against the high complication rate and potential mortality associated with surgical intervention in this patient population.

ABBREVIATIONS

DISH = diffuse idiopathic skeletal hyperostosis.

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  • 1

    Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013;9(12):741750.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

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

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

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

  • 4

    Diederichs G, Engelken F, Marshall LM, et al. Diffuse idiopathic skeletal hyperostosis (DISH): relation to vertebral fractures and bone density. Osteoporos Int. 2011;22(6):17891797.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Balling H, Weckbach A. Hyperextension injuries of the thoracolumbar spine in diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976). 2015;40(2):E61E67.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Matějka J, Skála-Rosenbaum J, Krbec M, Zeman J, Matějka T, Zeman P. Type AO/ASIF B3 fractures of the thoracic and lumbar spine. Article in Czech. Acta Chir Orthop Traumatol Cech. 2013;80(5):335340.

    • Search Google Scholar
    • Export Citation
  • 7

    Taher AW, Page PS, Greeneway GP, et al. Spinal fractures in the setting of diffuse idiopathic skeletal hyperostosis conservatively treated via orthosis: illustrative cases. J Neurosurg Case Lessons. 2022;3(20):CASE21689.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Okada E, Ishihara S, Azuma K, et al. Metabolic syndrome is a predisposing factor for diffuse idiopathic skeletal hyperostosis. Neurospine. 2021;18(1):109116.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Boachie-Adjei O, Bullough PG. Incidence of ankylosing hyperostosis of the spine (Forestier’s disease) at autopsy. Spine (Phila Pa 1976). 1987;12(8):739743.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Cirillo TJI, Gimbernat RM, Farías MI, Hernández Vargas G, Urzúa BA, Ballesteros PJV. Hyperextension-distraction fractures in ankylosing and spondylotic spines: injury profile and treatment results. Int Orthop. 2022;46(4):889895.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010;35(11):E458E464.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Kuroki H, Higa K, Chosa E. Clinical results of vertebral fracture related to diffuse idiopathic skeletal hyperostosis (DISH) which underwent conservative treatment: three case reports. Int J Spine Surg. 2021;15(1):195202.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Saita K, Monobe Y, Ogihara S, et al. A case of vertebral fracture associated with diffuse idiopathic skeletal hyperostosis treated by a successful conservative treatment. Spine Surg Relat Res. 2018;3(4):401403.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Okano I, Tachibana T, Nishi M, et al. Conservative treatment for stable low-energy thoracolumbar vertebral fractures in nonfused segments among elderly patients with diffuse idiopathic skeletal hyperostosis: a matched case-control study. Medicine (Baltimore). 2019;98(24):e16032.

    • Crossref
    • Search Google Scholar
    • Export Citation

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