Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland.
Eur Radiol. 2023 Dec;33(12):9425-9433. doi: 10.1007/s00330-023-09866-9. Epub 2023 Jun 29.
To determine the incidence of spinal hematoma and its relation to neurological deficit after trauma in patients with spinal ankylosis from diffuse idiopathic skeletal hyperostosis (DISH).
A retrospective review of 2256 urgent or emergency MRI referrals over a period of 8 years and nine months revealed 70 DISH patients who underwent CT and MRI scans of the spine. Spinal hematoma was the primary outcome. Additional variables were spinal cord impingement, spinal cord injury (SCI), trauma mechanism, fracture type, spinal canal narrowing, treatment type, and Frankel grades during injury, before and after treatment. Two trauma radiologists reviewed MRI scans blinded to initial reports.
Of 70 post-traumatic patients (54 men, median age 73, IQR 66-81) with ankylosis of the spine from DISH, 34 (49%) had spinal epidural hematoma (SEH) and 3 (4%) had spinal subdural hematoma, 47 (67%) had spinal cord impingement, and 43 (61%) had SCI. Ground-level fall (69%) was the most common trauma mechanism. A transverse, AO classification type B spine fracture (39%) through the vertebral body was the most common injury type. Spinal canal narrowing (p < .001) correlated and spinal cord impingement (p = .004) associated with Frankel grade before treatment. Of 34 patients with SEH, one, treated conservatively, developed SCI.
SEH is a common complication after low-energy trauma in patients with spinal ankylosis from DISH. SEH causing spinal cord impingement may progress to SCI if not treated by decompression.
Low-energy trauma may cause unstable spinal fractures in patients with spinal ankylosis caused by DISH. The diagnosis of spinal cord impingement or injury requires MRI, especially for the exclusion of spinal hematoma requiring surgical evacuation.
• Spinal epidural hematoma is a common complication in post-traumatic patients with spinal ankylosis from DISH. • Most fractures and associated spinal hematomas in patients with spinal ankylosis from DISH result from low-energy trauma. • Spinal hematoma can cause spinal cord impingement, which may lead to SCI if not treated by decompression.
确定弥漫性特发性骨肥厚（DISH）脊柱强直患者创伤后脊柱血肿的发生率及其与神经功能缺损的关系。
对 8 年零 9 个月期间的 2256 例紧急或急诊 MRI 转诊患者进行回顾性分析，发现 70 例 DISH 患者进行了 CT 和 MRI 脊柱扫描。脊柱血肿为主要结局。其他变量包括脊髓压迫、脊髓损伤（SCI）、创伤机制、骨折类型、椎管狭窄、治疗类型以及受伤时、治疗前后的 Frankel 分级。两名创伤放射科医生在不参考初始报告的情况下对 MRI 扫描进行了盲法评估。
70 例创伤后患者（54 例男性，中位年龄 73 岁，IQR 66-81）中，34 例（49%）患有脊柱硬膜外血肿（SEH），3 例（4%）患有脊柱硬脑膜下血肿，47 例（67%）患有脊髓压迫，43 例（61%）患有 SCI。平地跌倒（69%）是最常见的创伤机制。最常见的损伤类型是通过椎体的横向、AO 分类 B 型脊柱骨折（39%）。椎管狭窄（p<.001）与治疗前脊髓压迫（p=.004）相关。34 例 SEH 患者中，1 例保守治疗后发生 SCI。
DISH 所致脊柱强直患者在低能量创伤后，SEH 是一种常见的并发症。如果不减压，导致脊髓压迫的 SEH 可能进展为 SCI。
低能量创伤可引起 DISH 引起的脊柱强直患者不稳定的脊柱骨折。脊髓压迫或损伤的诊断需要 MRI，特别是需要排除需要手术清除的脊柱血肿。
DISH 脊柱强直患者创伤后，脊柱硬膜外血肿是一种常见并发症。
DISH 脊柱强直患者的大多数骨折和相关脊柱血肿均由低能量创伤引起。
脊柱血肿可导致脊髓压迫，如不减压可导致 SCI。
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