TY - JOUR
T1 - Operative Outcomes after Cervical Diffuse Idiopathic Skeletal Hyperostosis Fracture in the Elderly
AU - Ozpinar, Alp
AU - Perez, Jennifer L.
AU - Hacker, Emily
AU - Alan, Nima
AU - Agarwal, Nitin
AU - Deng, Hansen
AU - Okonkwo, David O.
AU - Kanter, Adam S.
AU - Hamilton, D. Kojo
N1 - Publisher Copyright:
© International Society for the Advancement of Spine Surgery
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background: Cervical diffuse idiopathic skeletal hyperostosis (DISH) fractures are frequently unstable and carry significant risk of neurologic injury and death. Most patients with DISH fractures are elderly (>70 years) with significant comorbidities. We assessed factors that contribute to outcomes in elderly patients with cervical DISH fractures. Methods: Elderly patients with cervical DISH fractures from 2008 to 2017 were included in this retrospective multiinstitutional cohort study. Predictor variables included injury level, surgical approach, preinjury comorbidities, American Society of Anesthesiologists (ASA) score, American Spinal Injury Association (ASIA) impairment scale grade, preoperative anticoagulation status, and the subaxial cervical spine injury classification system (SLIC) score. Univariate and multivariate analyses were utilized to identify factors associated with 30-day mortality and ambulatory status at discharge. Results: A total of 48 patients, mean age 74.7 years old (range 60–96), underwent cervical fixation for DISH fractures. Average SLIC score was 6.30 ± 1.2 (range 5–8), and most frequent fracture level was at C6 to -C7 (31.3%) followed by C7–T1 (25.0%). Forty (83.3%) patients underwent posterior fixation, 7 (14.6%) with anterior fixation, and 1 (2.1%) had combined approach. Ten (20.4%) patients died within 30 days of surgery. Multivariate analysis demonstrated that poorer preoperative ASIA grade (OR 2.35, P = 0.003, CI = 1.33–4.14) and ASA score >3 (P = 0.027) had increased risk of being nonambulatory at discharge. Higher SLIC score was associated with increased 30-day mortality (P = 0.021, CI = 1.20–9.60). Conclusions: Cervical DISH fractures can be highly unstable, for which instrumentation and fixation are indicated. Surgical decision-making should focus on preoperative ASIA grade, SLIC score, and ASA score. Clinical Relevance: The study is relevant due to an aging poulation predisposed to cervical DISH fractures.
AB - Background: Cervical diffuse idiopathic skeletal hyperostosis (DISH) fractures are frequently unstable and carry significant risk of neurologic injury and death. Most patients with DISH fractures are elderly (>70 years) with significant comorbidities. We assessed factors that contribute to outcomes in elderly patients with cervical DISH fractures. Methods: Elderly patients with cervical DISH fractures from 2008 to 2017 were included in this retrospective multiinstitutional cohort study. Predictor variables included injury level, surgical approach, preinjury comorbidities, American Society of Anesthesiologists (ASA) score, American Spinal Injury Association (ASIA) impairment scale grade, preoperative anticoagulation status, and the subaxial cervical spine injury classification system (SLIC) score. Univariate and multivariate analyses were utilized to identify factors associated with 30-day mortality and ambulatory status at discharge. Results: A total of 48 patients, mean age 74.7 years old (range 60–96), underwent cervical fixation for DISH fractures. Average SLIC score was 6.30 ± 1.2 (range 5–8), and most frequent fracture level was at C6 to -C7 (31.3%) followed by C7–T1 (25.0%). Forty (83.3%) patients underwent posterior fixation, 7 (14.6%) with anterior fixation, and 1 (2.1%) had combined approach. Ten (20.4%) patients died within 30 days of surgery. Multivariate analysis demonstrated that poorer preoperative ASIA grade (OR 2.35, P = 0.003, CI = 1.33–4.14) and ASA score >3 (P = 0.027) had increased risk of being nonambulatory at discharge. Higher SLIC score was associated with increased 30-day mortality (P = 0.021, CI = 1.20–9.60). Conclusions: Cervical DISH fractures can be highly unstable, for which instrumentation and fixation are indicated. Surgical decision-making should focus on preoperative ASIA grade, SLIC score, and ASA score. Clinical Relevance: The study is relevant due to an aging poulation predisposed to cervical DISH fractures.
KW - DISH
KW - diffuse idiopathic skeletal hyperostosis
KW - elderly
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85134303416&partnerID=8YFLogxK
U2 - 10.14444/8252
DO - 10.14444/8252
M3 - Article
C2 - 35772980
AN - SCOPUS:85134303416
SN - 2211-4599
VL - 16
SP - 435
EP - 441
JO - International Journal of Spine Surgery
JF - International Journal of Spine Surgery
IS - 3
ER -