Abstract
A 73-year-old woman fell backward from a standing position onto a chair 50cm in height.
During the week after injury, her back pain gradually increased without any neurologic symptom. MRI showed a Th11 vertebral fracture and she was admitted to our hospital. Computed tomography (CT) revealed a fracture line that extended from the Th11 vertebra to the Th9 spinous process, with ossification of the anterior longitudinal ligament (OALL) from Th6 to L1, thus satisfying the criteria for diffuse idiopathic skeletal hyperostosis (DISH). There was no deficit in the vertebral wall, or any compression of the spinal cord. Three weeks after the injury, we performed balloon kyphoplasty because 1) conservative treatment for this 3-column injury with DISH would have required a long period of bed rest and carried a high risk of non-union, 2) there was minimal bone loss in the vertebral body, and 3) delayed anterior cement dislocation would have been less likely due to massive OALL. On the first postoperative day, the patient's back pain was relieved and she started walking with a hard brace. Two months after the operation, the brace was successfully removed because bone union had been confirmed by CT. Although vertebral fractures with DISH often require instrumentation surgery, BKP can be a good choice in carefully selected patients.
