title: Cervical spine trauma in diffuse idiopathic skeletal hyperostosis: injury characteristics and outcome with surgical treatment.
abstract: METHODS
  Retrospective study of a consecutive series of operatively managed patients with cervical fractures with diffuse idiopathic skeletal hyperostosis (DISH) presenting to 3 institutions over an 8 year period.
  
  
  OBJECTIVE
  Assess demographics, fracture characteristics, outcome and complications in patients managed surgically.
  
  
  BACKGROUND
  Cervical spine injuries related to DISH represent a difficult subgroup of trauma patients to treat. This subset is fraught with potential complications related to the injury of the ankylosed spine, high rate of co-morbidities, and older demographics. The data in the literature on treatment, outcomes and complications is largely comprised of case reports and small case series.
  
  
  METHODS
  All patients with cervical fractures in the setting of DISH between January 2001 and December 2008 were reviewed retrospectively. Charts and radiographs were reviewed assessing demographics, injury characteristics and short-term outcomes. Statistical analysis was performed analyzing the impact of distinct parameters on the incidence of medical and surgical complications.
  
  
  RESULTS
  Thirty-three patients with age 73.8 ± 11 years were identified. DISH-affected segments numbered 5.5 ± 2.1. Injury severity as assessed by the Subaxial-Injury-Classification scoring-system (SLIC) averaged 7.2 ± 1.4 points. 7 patients (20.6%) were ASIA-A on admission, 4 (11.8%) ASIA-B, 4 (11.8%) ASIA-C, 10 (29.4%) ASIA-D, and 7 (20.6%) ASIA-E. All but 2 patients (6%) had medical co-morbidities. Inpatient stay was 26.6 ± 23.4 days. 16 patients (47%) had anterior, 12 patients (35.3%) had posterior, and 5 patients (14.7%) had combined anterior-posterior instrumented fusion. 25 patients (73.5%) had medical/surgical complications. 20 patients (58.8%) suffered serious pulmonary complications not related to the neurologic injury (p < 0.05). Nine patients (26.5%) had died. Seven patients (20.6%) showed improved ASIA-scores, 18 patients (52.9%) had no improvement and 2 patients (5.9%) deteriorated.
  
  
  CONCLUSIONS
  The current findings pinpoint the potential for medical and surgical complications in this high risk subgroup. Surgeons should be aware of the unique aspects associated with treatment of these injuries.
authors.affiliation: Department of Orthopaedics and Sports Medicine, Harborview Medical Center/University of Washington Medical Center, Seattle, WA, USA. rbransfo@uw.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bransford
authors.forename: Heiko
authors.initials: H
authors.lastname: Koller
authors.forename: Troy
authors.initials: T
authors.lastname: Caron
authors.forename: Juliane
authors.initials: J
authors.lastname: Zenner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hitzl
authors.forename: Andre
authors.initials: A
authors.lastname: Tomasino
authors.forename: Michael
authors.initials: M
authors.lastname: Mayer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001317:Austria; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D015601:Injury Severity Score; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009519:New York City; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014861:Washington