Clinical Results of Vertebral Fracture Related to Diffuse Idiopathic Skeletal Hyperostosis (DISH) Which Underwent Conservative Treatment: Three Case Reports

Abstract

Background: A vertebral fracture in a patient with diffuse idiopathic skeletal hyperostosis (DISH) is unstable due to larger moment via the long lever arm of an ankylosed spine. Therefore, surgical treatment is commonly recommended to avoid complications of nonunion and paralysis. In this report, we present 3 cases of vertebral fractures related to DISH which were primarily forced to undertake conservative treatment because of medical comorbidities and advanced age.Case 1: A 93-year-old woman suffered from T10 vertebral fracture by a ground-level fall on her back. A trunk cast for 6 weeks was followed by brace wear for 3 months with administration of daily teriparatide. Then complete bone union was confirmed at 2 years after injury without back pain.Case 2: An 84-year-old man suffered from T12 vertebral fracture by a fall on his back from a chair. A trunk cast for 12 weeks was followed by brace wear for 6 months with administration of daily teriparatide. Then acceptable bone union was confirmed at 1 year after the injury, and activities of daily living became independent.Case 3: An 87-year-old woman suffered from T10 vertebral fracture due to a ground-level fall on her back when doing pruning work. Conservative treatment by trunk cast was first initiated with administration of daily teriparatide. However, delayed paralysis developed at 2 weeks after casting, so minimally invasive spinal stabilization (MISt) was performed. Bone union was obtained at 1 year after the injury without any neurological impairment.Conclusions: Favorable clinical courses have been obtained in 2 cases, whereas MISt was required for delayed paralysis in 1 case. Although surgical stabilization is the first-line treatment for vertebral fracture with DISH, conservative treatment can also be one of the options in cases with high operative risk due to serious medical comorbidities. However, during conservative treatment, cautious observation is necessary not to overlook the occurrence of paralysis.Level of Evidence: 4. Clinical Relevance: Conservative treatment for vertebral fracture with DISH can be one of the options in cases with high operative risk due to serious medical comorbidities.

Percutaneous kyphoplasty for the treatment of diffuse idiopathic skeletal hyperostosis with vertebral fractures: A case report and treatment review

“…The prevalence of We reviewed the treatments and results on DISH with vertebral fractures in Table 1. Taking drugs and wearing braces are often used as conservative treatments for patients who cannot tolerate surgery (8,10,13,14). Since DISH patients often have age-related complications such as osteoporosis and cardiopulmonary dysfunction, drugs and braces are not always effective and cannot stop the progression of the disease (3,5,17).…”

Spinal fractures in the setting of diffuse idiopathic skeletal hyperostosis conservatively treated via orthosis: illustrative cases

“…In our study we provide a brief case series describing how in these settings clinicians can opt for a nonoperative approach. 17 , 21 This is important to avoid the inherent risk of operating and may serve to benefit cases that necessitate a conservative approach.…”

Progressive spinal destruction secondary to minimal vertebral fracture in a patient with diffuse idiopathic skeletal hyperostosis: a case report

“…Some case reports have described successful treatment with a trunk cast and daily teriparatide injections. [13][14][15][16][17] If this method had been adopted for our patient in the early phase of treatment, bone union could have been achieved.…”