TY - JOUR
T1 - Risk factors for delayed diagnosis of spinal fracture associated with diffuse idiopathic skeletal hyperostosis
T2 - A nationwide multiinstitution survey
AU - Kobayashi, Kazuyoshi
AU - Okada, Eijiro
AU - Yoshii, Toshitaka
AU - Tsushima, Mikito
AU - Yamada, Tsuyoshi
AU - Watanabe, Kei
AU - Katsumi, Keiichi
AU - Hiyama, Akihiko
AU - Katoh, Hiroyuki
AU - Watanabe, Masahiko
AU - Nakagawa, Yukihiro
AU - Okada, Motohiro
AU - Endo, Teruaki
AU - Shiraishi, Yasuyuki
AU - Takeuchi, Kazuhiro
AU - Matsunaga, Shunji
AU - Maruo, Keishi
AU - Sakai, Kenichiro
AU - Kobayashi, Sho
AU - Ohba, Tetsuro
AU - Wada, Kanichiro
AU - Ohya, Junichi
AU - Mori, Kanji
AU - Nishimura, Hirosuke
AU - Tsuji, Takashi
AU - Watanabe, Kota
AU - Okawa, Atsushi
AU - Matsumoto, Morio
AU - Imagama, Shiro
N1 - Funding Information:
Kazuyoshi Kobayashi, Eijiro Okada, Toshitaka Yoshii, Mikito Tsushima, Tsuyoshi Yamada, Kei Watanabe, Keiichi Katsumi, Hiroyuki Katoh, Akihiko Hiyama, Masahiko Watanabe, Yukihiro Nakagawa, Motohiro Okada, Teruaki Endo, Yasuyuki Shiraishi, Kazuhiro Takeuchi, Shunji Matsunaga, Keishi Maruo, Kenichiro Sakai, Sho Kobayashi, Tetsuro Ohba, Kanichiro Wada, Junichi Ohya, Kanji Mori, Hirosuke Nishimura, Takashi Tsuji, Kota Watanabe, Atsushi Okawa, Morio Matsumoto, and Shiro Imagama were received a Japanese Health Labor Sciences Research Grant No.038.Tsuyoshi Yamada, Akihiko Hiyama, Hiroyuki Katoh, Yasuyuki Shiraishi, Kazuhiro Takeuchi, Kenichiro Sakai, Kanichiro Wada, Kota Watanabe, and Morio Matsumoto were received a Japan Agency for Medical Research and Development JP15ek0109136.
Publisher Copyright:
© 2020
PY - 2021/11
Y1 - 2021/11
N2 - Background: Patients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH). Methods: The subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made >24 h after injury. Results: Main causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p < 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P < 0.05) and Frankel grade E at the time of injury (OR 2.29; P < 0.01) were significantly associated with delayed diagnosis. Conclusion: In patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration.
AB - Background: Patients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH). Methods: The subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made >24 h after injury. Results: Main causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p < 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P < 0.05) and Frankel grade E at the time of injury (OR 2.29; P < 0.01) were significantly associated with delayed diagnosis. Conclusion: In patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration.
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U2 - 10.1016/j.jos.2020.10.019
DO - 10.1016/j.jos.2020.10.019
M3 - Article
C2 - 33334624
AN - SCOPUS:85097676908
SN - 0949-2658
VL - 26
SP - 968
EP - 973
JO - Journal of Orthopaedic Science
JF - Journal of Orthopaedic Science
IS - 6
ER -
