Ozpinar Alp, Perez Jennifer L, Hacker Emily, Alan Nima, Agarwal Nitin, Deng Hansen, Okonkwo David O, Kanter Adam S, Hamilton D K
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Neurosurgical Spine Services Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Int J Spine Surg. 2022 Jun;16(3):435-441. doi: 10.14444/8252.
Cervical diffuse idiopathic skeletal hyperostosis (DISH) fractures are frequently unstable and carry significant risk of neurologic injury and death. Most patients with DISH fractures are elderly (>70 years) with significant comorbidities. We assessed factors that contribute to outcomes in elderly patients with cervical DISH fractures.
Elderly patients with cervical DISH fractures from 2008 to 2017 were included in this retrospective multi-institutional cohort study. Predictor variables included injury level, surgical approach, preinjury comorbidities, American Society of Anesthesiologists (ASA) score, American Spinal Injury Association (ASIA) impairment scale grade, preoperative anticoagulation status, and the subaxial cervical spine injury classification system (SLIC) score. Univariate and multivariate analyses were utilized to identify factors associated with 30-day mortality and ambulatory status at discharge.
A total of 48 patients, mean age 74.7 years old (range 60-96), underwent cervical fixation for DISH fractures. Average SLIC score was 6.30 ± 1.2 (range 5-8), and most frequent fracture level was at C6 to -C7 (31.3%) followed by C7-T1 (25.0%). Forty (83.3%) patients underwent posterior fixation, 7 (14.6%) with anterior fixation, and 1 (2.1%) had combined approach. Ten (20.4%) patients died within 30 days of surgery. Multivariate analysis demonstrated that poorer preoperative ASIA grade (OR 2.35, = 0.003, CI = 1.33-4.14) and ASA score >3 ( = 0.027) had increased risk of being nonambulatory at discharge. Higher SLIC score was associated with increased 30-day mortality ( = 0.021, CI = 1.20-9.60).
Cervical DISH fractures can be highly unstable, for which instrumentation and fixation are indicated. Surgical decision-making should focus on preoperative ASIA grade, SLIC score, and ASA score.
The study is relevant due to an aging poulation predisposed to cervical DISH fractures.
颈椎弥漫性特发性骨肥厚（DISH）骨折通常不稳定，具有显著的神经损伤和死亡风险。大多数DISH骨折患者为老年人（>70岁），且伴有严重的合并症。我们评估了影响老年颈椎DISH骨折患者预后的因素。
本回顾性多机构队列研究纳入了2008年至2017年的老年颈椎DISH骨折患者。预测变量包括损伤节段、手术入路、伤前合并症、美国麻醉医师协会（ASA）评分、美国脊髓损伤协会（ASIA）损伤分级、术前抗凝状态以及下颈椎损伤分类系统（SLIC）评分。采用单因素和多因素分析来确定与30天死亡率和出院时活动状态相关的因素。
共有48例患者，平均年龄74.7岁（范围60 - 96岁），因DISH骨折接受颈椎固定术。平均SLIC评分为6.30±1.2（范围5 - 8），最常见的骨折节段为C6至C7（31.3%），其次是C7 - T1（25.0%）。40例（83.3%）患者接受了后路固定，7例（14.6%）接受前路固定，1例（2.1%）采用联合入路。10例（20.4%）患者在术后30天内死亡。多因素分析表明，术前ASIA分级较差（OR 2.35，P = = 0.003，CI = 1.33 - 4.14）和ASA评分>3（P = 0.027）会增加出院时不能行走的风险。较高的SLIC评分与30天死亡率增加相关（P = 0.021，CI = 1.20 - 9.60）。
颈椎DISH骨折可能高度不稳定，需要进行器械固定。手术决策应侧重于术前ASIA分级、SLIC评分和ASA评分。
由于老年人群易患颈椎DISH骨折，本研究具有相关性。
