Association Between Trauma-Induced Vertebral Fractures and Motor Weakness in Patients With Diffuse Idiopathic Skeletal Hyperostosis

Background Diffuse idiopathic skeletal hyperostosis (DISH) is an age-related condition involving abnormal ossification of soft tissues, including ligaments and joint capsules. Patients with DISH have an increased risk of fractures, especially in ankylosed spines, which increases susceptibility to spinal cord injury. This study aimed to explore the risk factors for neurological symptoms in patients with DISH-related fractures. Material and methods In this retrospective single-center study, 34 patients with fractures of the DISH-ankylosed segment who underwent surgical treatment were included. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to investigate the fracture type, degree of displacement, rate of spinal canal stenosis, and presence of posterior column injury. Radiographic and clinical risk factors for paralysis, defined as American Spinal Injury Association impairment scale grades A, B, C and D) and sensory disturbances were analyzed. Neurological prognosis was also examined. Results Of the 34 patients with DISH-related vertebral fractures treated by surgery, 16 (47%) experienced fracture-related paralysis. The mean patient age was 75.0 years, with 29 men and five women. Four patients (25%) showed postoperative neurological improvements. Injuries up to the posterior column and a high spinal canal stenosis rate on CT sagittal images were risk factors for paralysis. The cut-off values for CT and MRI stenosis rates were 32% and 55%, respectively. Conclusions Approximately half of DISH-related spinal fractures result in paralysis. Severe spinal canal stenosis on sagittal CT and MR was identified as a risk factor for paralysis, with cutoff values of 32% and 55%, respectively. In suspected cases of suspected DISH-related fracture, early CT and MRI are recommended. In cases with a high risk of paralysis, early surgical intervention may be indicated to prevent late-onset paralysis.