Association Between Trauma-Induced Vertebral Fractures and Motor Weakness in Patients With Diffuse Idiopathic Skeletal Hyperostosis

Cureus, 2024 · DOI: 10.7759/cureus.76403 · Published: December 26, 2024

Simple Explanation

Diffuse idiopathic skeletal hyperostosis (DISH) is an age-related condition involving abnormal ossification of soft tissues, including ligaments and joint capsules. Patients with DISH have an increased risk of fractures, especially in ankylosed spines, which increases susceptibility to spinal cord injury. An ankylosed spine is four times more likely to experience a fracture in its lifetime than a non-ankylosed spine, with a 58% higher risk of associated spinal cord injury. Approximately half of DISH-related spinal fractures result in paralysis. Severe spinal canal stenosis on sagittal CT and MR was identified as a risk factor for paralysis, with cutoff values of 32% and 55%, respectively.

Study Duration

January 2012 and December 2022

Participants

34 patients with fractures of the DISH-ankylosed segment

Evidence Level

Not specified

Key Findings

1
Approximately half of DISH-related spinal fractures were accompanied by neurological symptoms, and 41% of the patients exhibited paralysis.
2
Injuries up to the posterior column and a high spinal canal stenosis rate on CT sagittal images were risk factors for paralysis.
3
The cut-off values for CT and MRI stenosis rates were 32% and 55%, respectively.

Research Summary

Approximately half of the DISH-related spinal fractures were accompanied by neurological symptoms, and 41% of the patients exhibited paralysis. Severe spinal canal stenosis on sagittal CT and MR was identified as a risk factor for paralysis, with cutoff values of 32% and 55%, respectively. In cases where paralysis is a high risk, early surgical intervention may be a crucial step in the clinical management plan, provided that an accurate diagnosis is made at the time of the initial examination.

Practical Implications

Early Diagnosis via Imaging

Early CT and MRI are recommended in suspected cases of DISH-related fracture to assess spinal canal stenosis and risk of paralysis.

Early Surgical Intervention

In cases with a high risk of paralysis (stenosis rate >32% on CT or >55% on MRI), early surgical intervention may be indicated to prevent late-onset paralysis.

Comprehensive Assessment

A comprehensive assessment of paralysis risk can be achieved by combining both CT and MRI examinations.

Study Limitations

1
Small-scale, single-center retrospective study.
2
Possibility of selection bias could not be excluded.
3
Study exclusively focused on surgical cases and did not consider conservative treatment cases.

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