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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2024, Number 1

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Cir Columna 2024; 2 (1)

Diffuse idiopathic skeletal hyperostosis, risk factor for cervical fracture: an underdiagnosed disease

Herrera ROC, Arceo VD, Jiménez CEE, Coria RJD

Language: Spanish
References: 15
Page: 34-39
PDF size: 296.39 Kb.


ABSTRACT

Introduction: diffuse idiopathic skeletal hyperostosis (DISH) is defined as a systemic disease characterized by an enthesopathy that can affect both the spinal column and extraspinal structures.The importance of vertebral fractures with DISH lies in the fact that the mechanism of injury tends to be, mostly of low intensity, from a standing or sitting position.The objective of this review was to find updates regarding DISH and its relationship with cervical fractures, diagnosis and management, in order to understand and improve aspects such as delay in diagnosis and associated neurological injury. Material and methods: a systematic review of the literature was carried out on 4 different platforms, including PubMed, Scielo, Google Scholar and Science Direct from 2010 to 2023. Of 26 articles, articles not related to the medical area were taken as excluded, such as those they only described DISH. Results: of 26 articles reviewed, 15 met inclusion criteria for this systematic review, with a focus on the association of cervical fractures with DISH, description and development of pathology. Where it was concluded that there is no predominance in both sexes, cervical spine fractures are mostly due to trivial trauma, delay in diagnosis being defined as greater than 24 hours after the injury, neurological compromise, Frankel C, and dysphagia as one of the the main symptoms in DISH at the cervical level. Early surgical management shows improvement in symptoms after 7 days. Posterior decompression was chosen, due to the poor bone quality due to DISH, which shows loosening of material as a complication due to anterior approach management. Conclusion: cervical fractures in association with DISH in a percentage of studies are overlooked in low energy traumas.The cervical level is not the most frequent for fractures compared to the thoracic and lumbar. However, it is the one with the greatest neurological compromise at the time of the injury. It was observed that there is severe paralysis in the cervical spine immediately after the injury, even without a fracture of the posterior column; fractures at this level are considered unstable.For diagnosis in the absence of symptoms, diagnostic criteria for DISH, trivial trauma, it is advisable to perform a CT or MRI. Better results are shown, with a timely diagnosis, less than 24 hours, in suspected cervical fracture in association with DISH, early decompressionshows better results, with respect to neurological injury. Conservative management is reserved for patients with severe comorbidities.


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