When diffuse idiopathic skeletal hyperostosis (DISH) leads to an ankylosed spine, trauma carries a substantially elevated risk of spinal fracture. An unstable fracture in this setting requires a specific surgical management pathway distinct from standard spinal fracture care.
An ankylosed spine resulting from DISH is a recognised risk factor for spinal fracture following trauma. In patients presenting with an unstable spinal fracture in this context, surgical intervention is indicated. The rigidity and deformity of the cervical spine also require particular care during patient positioning and airway management.
The preferred approach centres on posterior surgical stabilization, extending fixation over multiple spinal levels on either side of the fracture — the complete technique selection criteria, procedural scope, and clinical decision algorithm are available in the full protocol.
Surgical interventions might be required in cases of severe symptomatic cervical DISH and for unstable spinal fractures.
For trauma patients, the most important consequence of an ankylosed spine as a result of DISH is the elevated fracture risk of the spine.
The intubation process could be compromised by the stiff and deformed cervical ankylosed spine, positioning/manipulation of the patient should be performed with utmost care and posterior stabilization is currently the preferred method with fixation of at least three levels above and three levels below the fracture.
Percutaneous pedicle screw-based fixation techniques are therefore the favored method for thoracolumbar B3 or C type fractures without neurological deficit.
DOI: 10.1016/j.berh.2020.101527
View source ↗