title: CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dept. of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Eijiro
authors.initials: E
authors.lastname: Okada
authors.affiliation: Dept. of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsuji
authors.affiliation: Dept. of Orthopaedic Surgery, Sano General Hospital, Tochigi, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Dept. of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kato
authors.affiliation: Dept. of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: Dept. of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Kaneko
authors.affiliation: Dept. of Orthopaedic Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Ogawa
authors.affiliation: Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Keio Spine Research Group, Tokyo, Japan. Electronic address: morio@a5.keio.jp.
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D015331:Cohort Studies; D000072700:Conservative Treatment / Q000379:methods; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000150:complications* / Q000000981:diagnostic imaging; D015601:Injury Severity Score; D007564:Japan; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D014057:Tomography, X-Ray Computed / Q000379:methods