Abstract
INTRODUCTION: Diffuse idiopathic skeletal hyperostosis (DISH)-related fractures have a high frequency of delayed diagnosis and paralysis even if caused by low-energy trauma, which makes diagnosing vertebral fractures (VFs) with DISH challenging. This study compared the clinical and radiologic features of VFs with DISH. METHODS: This study included 252 patients (70 men and 182 women; mean age±standard deviation, 81.0±8.6 years) with VFs in this study. Patients were divided into two groups depending on DISH (group D) or not (group N). We measured the sex, age, body mass index, hemoglobin A1c, and bone mineral density. This study also measured the spinopelvic sagittal alignments, local angular motion, inflection point, number of VFs, intervertebral disk (IVD) injury, and signal changes on magnetic resonance image (MRI). RESULTS: The presence of DISH in VFs was identified in 104 patients (41.3%) (49/70 [70.0%] in men vs. 55/182 [30.2%] in women). Group D was related to male sex, older age, larger thoracic kyphosis, VF at lower lumbar lesion, number of VFs, IVD injury, inflection point at lower lumbar, local angular motion, diffuse low signals on T1 MRI, and high or diffuse low signals on T2 MRI on univariant analysis. Multiple logistic regression analysis showed that the predictive factors for DISH were male sex, angular motion, VF at lower lumbar lesion, IVD injury, inflection point at lower lumbar, and diffuse low signals on T1 MRI. CONCLUSIONS: DISH was related to IVD injury, angular motion, and diffuse low signals on T1 MRI. In addition, VFs with DISH were more frequently found in men at the lower lumbar lesion than in women at thoracolumbar. When physicians detect these factors, attention should be given to VFs with DISH, and whole-spine computed tomography should be considered not to overlook the presence of DISH.