Surgical versus Nonsurgical Management of Traumatic Fracture in Geriatric Patients with Diffuse Idiopathic Skeletal Hyperostosis

Abstract Patients with Diffuse Idiopathic Skeletal Hyperostosis (DISH) are at increased risk for fracture with low-impact trauma. DISH is more often seen in the elderly, who may be at greater risk for postoperative complications. There remains a paucity of literature guiding surgical management for this patient population, which this study seeks to address. This was a retrospective review of geriatric (≥65) patients admitted to the urban level 1 trauma center for a large healthcare system from January 1, 2018, to December 31, 2022, with radiographic evidence of an acute spine fracture and DISH diagnosis. Patients were grouped as having surgical or nonsurgical management. Data was abstracted from the medical record and included demographics, injury information, radiological reports, and hospital course details. Study outcomes included differences between groups in discharge disposition, complications, 30-day mortality, length of stay (LOS), and intensive care unit LOS. Chi-squared tests or Fisher's exact tests were used for categorical variables. Continuous variables were presented as medians with interquartile range, compared to using the Wilcoxon Rank Sum test. A significant level of 0.05 was assumed for all tests. There were 21 patients included, with the majority (71%) in the nonsurgical group and the remainder (29%) in the surgical group. All had fractures of the cervical or thoracic spine and tended to be white (95%) males (86%) and had a median age of 85. Those who had surgery had a longer LOS compared with nonsurgical patients, 15 days vs. 4 days (p = 0.004). There were no differences in disposition, complication rate, or mortality between groups. Most nonsurgical patients had thoracic spine injuries (86%). Charlson Comorbidity Index was higher among the nonsurgical group compared with the surgical group, median 3 and 1.5, respectively (p = 0.034). Surgical decision-making in elderly patients with fractures in the setting of DISH is complex. The results of this study suggest that nonoperative management may be justified in this population, particularly those with significant comorbidities.