A case of diffuse idiopathic skeletal hyperostosis presenting delayed neurological deterioration following multiple vertebral body fractures

Abstract

We here in report a case of diffuse idiopathic skeletal hyperostosis (DISH) presenting delayed neurological deterioration following multiple vertebral body frac­tures. A 71-year-old man fell on his buttocks. The patient was treated conservatively as a diagnosis of sim­ple vertebral body compression fracture. One month later, he developed progressive motor weakness on his lower extremities and was transferred to our hospital. Neuroimaging studies revealed multiple vertebral body fractures (reverse Chance fracture on T11, old com­pres­sion fracture on T12, and Chance fracture on L1 vertebral body respectively) associated with extensive hyperostotic findings suggesting DISH. Because his neurological deterioration appeared to be caused by the spinal instability, posterior fixation underwent using pedicle screws and hooks combined with vertebroplasty. The patient was recovered to be ambula­tory 10 months after the surgery.

DISH may cause rigid mobility of the vertebral column leading unexpected vertebral body fractures and instabilities allowing delayed neurological deterioration. DISH is not rare even in Asian elderly people. If the vertebral fracture is found in elderly patients, CT and MRI recommend for diagnosing DISH.