1/13. Cervical spine control; bending the rules.Cervical spine fractures associated with diffuse idiopathic hyperostosis (DISH) are less common than those associated with ankylosing spondylitis and can occur after minor trauma in patients asymptomatic of the disease process. This case report describes a hyperextension injury of the neck in a patient unknown to have DISH, which resulted in an angulated C3/C4 fracture. The position of the fracture was improved by placing the neck in flexion with immediate improvement in the patient's neurological deficit.- - - - - - - - - - ranking = 1keywords = diffuse idiopathic, hyperostosis, idiopathic (Clic here for more details about this article) |
2/13. Spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis: a case report.STUDY DESIGN: We report on a 69-year-old male who had severe back pain due to spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis. OBJECTIVE: To describe a rare clinical entity and successful treatment by spinal fusion with a 4-year follow-up. SUMMARY OF BACKGROUND DATA: There have been a few reports of spontaneous symptomatic pseudoarthrosis of an intervertebral space associated with diffuse idiopathic skeletal hyperostosis, but there have been no reports of surgical treatment for this clinical condition. methods: Plain radiographs of the patient, who was admitted to our hospital with severe back pain but no history of trauma, revealed manifestations of diffuse idiopathic skeletal hyperostosis and a pseudoarthrosis at the T11-T12 intervertebral space. Posterior instrumentation from T9 to L2 and anterior bone grafting at the T11-T12 intervertebral space were performed. RESULTS: The patient has been followed for 4 years and is currently asymptomatic. CONCLUSIONS: A rare case of spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis was treated successfully by spinal fusion.- - - - - - - - - - ranking = 32.593782847583keywords = diffuse idiopathic skeletal hyperostosis, idiopathic skeletal hyperostosis, diffuse idiopathic, skeletal hyperostosis, hyperostosis, idiopathic (Clic here for more details about this article) |
3/13. Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture.Neurologic deficit secondary to a Jefferson fracture is rare, as the fracture fragments tend to spread outward. To the authors' knowledge, only five cases of vertebral artery injury associated with C1 fracture have been reported. A 75-year-old man with diffuse spinal hyperostosis hit the top of his head and sustained a Jefferson fracture. The patient presented with vertigo and slurred speech. Magnetic resonance (MR) imaging demonstrated cerebellar infarction, and MR angiography (MRA) showed bilateral vertebral artery occlusion associated with a Jefferson fracture. The patient was placed in a halo vest for a total of 11 weeks and treated with anticoagulant therapy. vertigo gradually improved, and the patient was able to walk with a cane. Previously slurred speech was completely resolved. This case demonstrates that a Jefferson fracture can cause vertebral artery occlusion, resulting in cerebellar infarction. The clinician should be aware of the possibility and implications of vertebral artery injuries, especially if a fracture involving the foramen transversarium with displacement is documented or if there is a neurologic deficit above the level of injury. Advances in noninvasive imaging such as MRA will facilitate accurate evaluation of these potentially life-threatening vascular injuries.- - - - - - - - - - ranking = 0.070291043579238keywords = hyperostosis (Clic here for more details about this article) |
4/13. Traumatic fracture-dislocation of C5 on C6 through a previously solid multilevel anterior cervical discectomy and fusion: a case report and review of the literature.BACKGROUND CONTEXT: Due to the underlying pathology and altered biomechanics, traumatic cervical fractures have been reported in patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), ossification of the posterior longitudinal ligament (OPLL), and combination of DISH and OPLL. However, incidence of a fracture-dislocation through a solid multilevel anterior cervical discectomy and fusion (ACDF) construct with no associated underlying pathology of AS, DISH, or OPLL but severe osteopenia has not, to the best knowledge of the authors, been reported in the medical literature. PURPOSE: To report the development of an unstable cervical spine fracture that occurred through a previous multilevel anterior cervical fusion and the challenges associated with the diagnosis and surgical management of these uncommon lesions. STUDY DESIGN/SETTING: A case report and review of the literature. methods: A case report entailing the clinical history, operative management, and postoperative course of a 72-year-old male patient with no known AS, DISH, or OPLL who suffered a cervical spine fracture-dislocation, secondary to a motor vehicle accident, through a previous solid three-level ACDF that was performed 20 years earlier. RESULTS: The patient underwent emergent reduction and realignment of the cervical fracture-dislocation, eventual posterior spinal fusion and stabilization with rigid segmental internal fixation, and application of external halo immobilization. At recent follow-up, he has radiographic evidence of fusion and maintenance of sagittal alignment without loss of reduction. CONCLUSIONS: Multilevel cervical fusion constructs are susceptible to traumatic injuries. Many of the same challenges in the management of the previously fused ACDF patient, who sustains a fracture-dislocation, are similar to those found in the patient with mass-inflammatory conditions or metabolic disorders, such as AS, DISH, or OPLL. In many cases, this includes severe osteopenia, long unstable fusion segments, and difficulties associated with prolonged halo vest immobilization. As a result, preoperative surgical planning should take into consideration the difficulties in achieving fracture reduction, decompression, and proper stabilization.- - - - - - - - - - ranking = 4.0742228559478keywords = diffuse idiopathic skeletal hyperostosis, idiopathic skeletal hyperostosis, diffuse idiopathic, skeletal hyperostosis, hyperostosis, idiopathic (Clic here for more details about this article) |
5/13. Systemic mastocytosis presenting with severe spinal osteopenia and multiple compression fractures.Systemic mastocytosis is a rare condition in which mast cells infiltrate various organs, including the skeleton. Because the mast cell secretes various bioactive substances that may induce bone resorption, this condition may cause generalized osteoporosis. We describe a case of a 28-year-old woman who presented with a painful thoracolumbar kyphosis due to generalized osteopenia and multiple pathological compression fractures and was found to have mastocytosis. She underwent operative stabilization of her kyphotic deformity with anterior interbody fusion and posterior Cotrel-Dubousset (CD) instrumentation and fusion. We conclude that mastocytosis should be suspected in an atypical case of so-called idiopathic osteoporosis.- - - - - - - - - - ranking = 0.00022700954579853keywords = idiopathic (Clic here for more details about this article) |
6/13. Fractures of the spine in diffuse idiopathic skeletal hyperostosis.Fractures of the spine in diffuse idiopathic skeletal hyperostosis (DISH) have rarely been reported. Only four cases could be found in the world literature. Eight new cases with nine fractures are reported in this study. The critical features are the frequent delays in diagnosis (three of eight patients) and the high rate of immediate and delayed neurologic deficit (seven of eight patients). Two fracture patterns occurred in this group. The first type occurred through the midportion of an ankylosed segment of the spine and involved the vertebral body (five fractures). The second type occurred at the top or bottom of a fused segment (four fractures). The latter were disk disruptions or odontoid fractures. This is a marked difference from spinal fractures in ankylosing spondylitis, in which the majority are transdiskal fractures. The difference can be explained on the basis of the different pathology of these two disease processes. Careful evaluation of patients with DISH who sustain trauma is critical. Treatment of this rare injury should be early stabilization of the spine to avoid complications of nonunion, deformity, neurologic injury, and death.- - - - - - - - - - ranking = 20.371114279739keywords = diffuse idiopathic skeletal hyperostosis, idiopathic skeletal hyperostosis, diffuse idiopathic, skeletal hyperostosis, hyperostosis, idiopathic (Clic here for more details about this article) |
7/13. Hyperextension fracture-dislocation of the thoracic spine with paraplegia in a patient with diffuse idiopathic skeletal hyperostosis.The case is described of a hyperextension thoracic spine fracture in a patient with diffuse idiopathic skeletal hyperostosis (DISH). A 70-year-old woman awoke paraplegic after retroperitoneal surgery after having been positioned in the hyperextended axially rotated position. Imaging demonstrated a T9-10 fracture-dislocation with severe pressure on the spinal cord, as well as findings typical of DISH. This case emphasizes the danger inherent in manipulating the ankylosed hyperostotic spine. It is proposed that patients undergoing surgery in this position should be evaluated for DISH as an additional risk factor.- - - - - - - - - - ranking = 20.371114279739keywords = diffuse idiopathic skeletal hyperostosis, idiopathic skeletal hyperostosis, diffuse idiopathic, skeletal hyperostosis, hyperostosis, idiopathic (Clic here for more details about this article) |
8/13. Vertebral pseudoarthrosis associated with diffuse idiopathic skeletal hyperostosis.Diffuse idiopathic skeletal hyperostosis is an ossifying diathesis that commonly affects the vertebral skeleton. Spinal ankylosis can occur, predisposing the spine to abnormal stresses and fracture. Fracture through an ankylosed segment with continued motion at the site of fracture can result in pseudoarthrosis. Pseudoarthrosis can also develop at the junction of the fused and mobile spine secondary to chronic abnormal stresses. This complication is manifest radiographically by single-level intervertebral disc space destruction, vertebral endplate erosions, marked vertebral sclerosis, and large osteophytes. The radiographic manifestations can mimic infective spondylitis or neuropathic changes.- - - - - - - - - - ranking = 17.811477118336keywords = diffuse idiopathic skeletal hyperostosis, idiopathic skeletal hyperostosis, diffuse idiopathic, skeletal hyperostosis, hyperostosis, idiopathic (Clic here for more details about this article) |
9/13. Hyperextension injuries of the thoracic spine in diffuse idiopathic skeletal hyperostosis. Report of four cases.Four patients who had multisegmental ankylosis of the thoracic and lumbar spine due to diffuse idiopathic skeletal hyperostosis sustained a hyperextension fracture-dislocation. The patients had a mean age of sixty-four years (range, fifty-eight to sixty-nine years); all four patients were men. All injuries occurred between the seventh and eleventh thoracic vertebrae. All patients had intact neurological function at the time of admission to the hospital. Three patients were managed with posterior spinal arthrodesis with Cotrel-Dubousset segmental instrumentation; one patient was managed non-operatively with a molded thoracolumbosacral orthosis. At a minimum duration of follow-up of twenty-two months (mean, twenty-seven months), the three patients who had been managed operatively had healing of the fracture with anatomical alignment of the spine and without postoperative complications. The one patient who had been managed non-operatively with a brace had severe neurological deterioration and non-anatomical alignment of the spine.- - - - - - - - - - ranking = 20.371114279739keywords = diffuse idiopathic skeletal hyperostosis, idiopathic skeletal hyperostosis, diffuse idiopathic, skeletal hyperostosis, hyperostosis, idiopathic (Clic here for more details about this article) |
10/13. Idiopathic juvenile osteoporosis.osteoporosis is the most common bone disease in adults, but rarely occurs in children. A seven year old boy with idiopathic juvenile osteoporosis is reported. X-ray investigation revealed moderate generalized osteoporosis with compression fractures and wedging of the thoracic and lumbar vertebral bodies. Clinical examination and biochemical investigations ruled out the known causes of osteoporosis in childhood. During the following four years he complained of back pain, but no new fractures appeared. Entering puberty he improved both clinically and radiologically without treatment.- - - - - - - - - - ranking = 0.00022700954579853keywords = idiopathic (Clic here for more details about this article) |
| | Next -> |