Okano Ichiro, Tachibana Tetsuya, Nishi Masanori, Midorikawa Yuki, Hoshino Yushi, Sawada Takatoshi, Kudo Yoshifumi, Toyone Tomoaki, Inagaki Katsunori
Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Koriyama, Fukushima.
Department of Orthopaedic Surgery, Showa University Koto Toyosu Hospital, Koto-ku.
Medicine (Baltimore). 2019 Jun;98(24):e16032. doi: 10.1097/MD.0000000000016032.
Diffuse idiopathic skeletal hyperostosis (DISH) is the spontaneous osseous fusion of the spine with anterior bridging osteophytes. It is well-known that conservative treatment for vertebral fractures of fused segment among DISH spines is associated with worse clinical outcomes. However, the prognosis of conservatively treated stable vertebral fractures in neighboring nonfused segments among DISH spines is still unknown. The purpose of this study was to analyze the results of conservative treatment of stable low-energy thoracolumbar (TL) vertebral fracture in nonfused segments among patients with DISH lesions.A total of 390 consecutive patients who visited an emergency department by ambulance with spinal trauma between 2013 and 2017 were retrospectively reviewed. The diagnosis of DISH was determined based on fused spinal segments with bridging osteophytes in at least 3 adjacent vertebrae. For each case of stable TL vertebral fractures in nonfused segments of the DISH spine, we identified 2 age-, sex-, and fracture lesion-matched non-DISH controls who underwent conservative treatment for low-energy TL vertebral fractures during the same period.Of the 33 identified cases of TL fractures with DISH, 14 met our inclusion criteria. The bony union rates of the DISH group and control group were 57% and 75% at the 3-month follow-up examination (P = .38) and 69% and 100% at the 6-month follow-up examination (P = .02), respectively. Among the 13 patients with fractures below the TL junction, fused segments were not diagnosable based on the initial standard radiographs of the lumbar spine for 61.5% of patients.Although this study design was exploratory and the sample size was small, our results suggest that with conservative treatment, stable fractures in nonfused segments in the DISH spine might have a worse prognosis than ordinary osteoporotic vertebral fractures. The diagnosis of coexisting DISH lesions can be missed when only radiographs of the lumbar spine are used to determine the diagnosis.
弥漫性特发性骨肥厚（DISH）是指脊柱的自发性骨融合并伴有前方桥接骨赘形成。众所周知，对于DISH脊柱融合节段的椎体骨折，保守治疗的临床效果较差。然而，DISH脊柱相邻未融合节段经保守治疗的稳定性椎体骨折的预后仍不清楚。本研究的目的是分析DISH病变患者未融合节段稳定性低能量胸腰椎（TL）椎体骨折的保守治疗结果。
回顾性分析了2013年至2017年间共390例因脊柱创伤通过救护车送往急诊科的连续患者。DISH的诊断基于至少3个相邻椎体有桥接骨赘的脊柱融合节段。对于DISH脊柱未融合节段的每例稳定性TL椎体骨折病例，我们确定了2例年龄、性别和骨折病变相匹配的非DISH对照，他们在同一时期接受了低能量TL椎体骨折的保守治疗。
在33例确诊的DISH TL骨折病例中，14例符合纳入标准。DISH组和对照组在3个月随访时的骨愈合率分别为５７％和７５％（Ｐ ＝ ０．３８），在6个月随访时分别为69％和100％（Ｐ ＝ ０．０２）。在13例TL节段以下骨折的患者中，61.5％的患者根据腰椎的初始标准X线片无法诊断融合节段。
尽管本研究设计具有探索性且样本量较小，但我们的结果表明，对于DISH脊柱未融合节段的稳定性骨折，保守治疗的预后可能比普通骨质疏松性椎体骨折更差。仅使用腰椎X线片进行诊断时，可能会漏诊并存的DISH病变。
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