Post‑traumatic spinal hematoma in diffuse idiopathic skeletal hyperostosis (DISH)

Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic disorder that leads to new bone formation and ankylosis, mainly in the thoracic and cervical spine. This condition predisposes patients to unstable fractures and spinal epidural hematoma (SEH), even from low-energy trauma. Spinal hematoma, particularly SEH, can occur after injury, originating from the epidural venous plexus or damaged bone. MRI is crucial for diagnosing spinal hematoma, and timely diagnosis and treatment are essential to prevent spinal cord impingement and potential permanent neurological impairment. This study aims to determine the incidence of spinal hematoma, identify major trauma mechanisms, and correlate these with neurological deficits in spinal trauma patients with ankylosis from DISH. The study involves a retrospective review of MRI scans by trauma radiologists blinded to initial reports.

• 1
  Spinal epidural hematoma (SEH) was found in 49% of post-traumatic patients with spinal ankylosis from DISH, while spinal subdural hematoma (SSH) was observed in 4%.
• 2
  Ground-level falls (69%) were the most common trauma mechanism leading to fractures and associated spinal hematomas in patients with spinal ankylosis from DISH.
• 3
  Spinal hematoma can cause spinal cord impingement, and if left untreated by decompression, it may progress to spinal cord injury (SCI).