外傷後に遅発性対麻痺を生じたびまん性特発性骨増殖症の１例

抄録

Introduction: Diffuse idiopathic skeletal hyperostosis (DISH) is a distinct clinical entity presenting extreme hyperostosis in vertebral bodies, differentiated from ankylosing spondylosis. We report a case of DISH with delayed thoracic and cervical spinal cord injuries fol­lowi­ng a minor trauma.

Case presentation: A 69–year–old man, with moder­ate mental retardation, fell forward in a street and was taken to a second emergency hospital, without neuro­logical deficits or abnormal findings on brain com­puted tomography. Thirty hours after the injury, he was taken to our hospital presenting urinary and fecal incontinence and total paraplegia. Anal reflex was absent. The neuroradiological findings showed un­stable fracture and spinal injury at T11 level, associated with extensive hyperostosis of anterior longitudinal, supraspinous, and interspinous ligaments, suggesting DISH. His posterior longitudinal ligament was ex­treme­ly ossified, and subarachnoid space was narrowed from the upper cervical to the upper thoracic spine. There was no cervical spinal injury. He underwent posterior fixation from T9 to L2, aiming for his early mobilization, three days after injury. Unfortunately, he got another cervical spinal cord injury, eleven days after the initial injury, causing dyspnea and tetra paresis, and he died of pneumonia fifty one days after the initial injury.

Discussion and Conclusion: DISH may cause de­creased mobility of the spinal column, leading to vertebral body fractures and instabilities followed by delayed neurological deterioration after minor trauma. Fractures in DISH must be carefully assessed for instability. Earlier diagnosis is needed allowing the chance of surgical treatment for unstable fractures to achieve better neurological outcomes. The surgical treatment may be from two to three above and below posterior spinal fixation. However, surgical indications should be carefully considered because of the high incidence of perioperative complications.