Risk factors for delayed diagnosis of spinal fracture associated with diffuse idiopathic skeletal hyperostosis: A nationwide multiinstitution survey

Kazuyoshi Kobayashi, Eijiro Okada, Toshitaka Yoshii, Mikito Tsushima, Tsuyoshi Yamada, Kei Watanabe, Keiichi Katsumi, Akihiko Hiyama, Hiroyuki Katoh, Masahiko Watanabe, Yukihiro Nakagawa, Motohiro Okada, Teruaki Endo, Yasuyuki Shiraishi, Kazuhiro Takeuchi, Shunji Matsunaga, Keishi Maruo, Kenichiro Sakai, Sho Kobayashi, Tetsuro OhbaKanichiro Wada, Junichi Ohya, Kanji Mori, Hirosuke Nishimura, Takashi Tsuji, Kota Watanabe, Atsushi Okawa, Morio Matsumoto, Shiro Imagama

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


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.

Original languageEnglish
Pages (from-to)968-973
Number of pages6
JournalJournal of Orthopaedic Science
Issue number6
Publication statusPublished - 2021 Nov

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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