Whole Spine CT Scan for the Detection of Acute Spinal Fractures in Diffuse Idiopathic Skeletal Hyperostosis Patients Who Sustained Low-energy Trauma

Christine Dan Lantsman, Gal Barkay, Alon Friedlander, Merav Barbi, Myriam Stern, Iris Eshed*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Study Design. Retrospective cohort study. Objective. The aim of this study was to evaluate the role and value of whole-spine computerized tomography (WSCT) versus radiographs and targeted CT to tender spinal regions in patients with diffuse idiopathic skeletal hyperostosis (DISH) after low-energy trauma. Summary of Background Data. Subjects with DISH are prone to spinal fractures even after low-impact trauma due to a rigid spinal structure. Methods. One-hundred forty-seven subjects (average age: 83 years, M:F 64/83) with verified DISH (Resnick and Niwayama radiographic criteria) on WSCT who were admitted to the emergency room (ER) after low-energy trauma and for whom there were radiographs of at least the thoracic and lumbar spine were evaluated for the presence of acute spinal fractures on both radiographs and WSCT. Agreement between fracture location and spinal tenderness location (cervical, thoracic, or lumbar) as reported in the medical record was evaluated. Results. Significantly more acute fractures were detected on WSCT compared to radiographs (55 and 32, P < 0.00001, respectively). The site of tenderness was not indicative of the fractured spinal segment in 57% of all acute fractures (seven cervical, 15 thoracic, and 16 lumbar). No fracture was detected on WSCT in 10 subjects with an unspecified pain location. Multilevel distant fractures were detected in two patients with a specified pain location to only one of the fractures. Conclusion. WSCT in DISH subjects after low-impact trauma is mandatory due to the high prevalence of acute fractures and the low specificity for fracture detection on radiographs. A targeted CT approach to the tender spinal segment proved to be inadequate and would have missed 57% of the acute single fractures with incompatible spinal tenderness location. These results support the significant role of WSCT in the ER setting for detecting and pinpointing the spinal fracture site of DISH subjects who present with low-impact trauma. Level of Evidence: 3.

Original languageEnglish
Pages (from-to)1348-1353
Number of pages6
JournalSpine
Volume45
Issue number19
DOIs
StatePublished - 1 Oct 2020
Externally publishedYes

Keywords

  • ankylosis
  • diffuse idiopathic skeletal hyperostosis
  • emergency room
  • fracture
  • low-energy trauma
  • pain
  • radiograph
  • spine
  • vertebral fractures
  • whole-spine CT

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