Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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May 16, 2016
Diffuse Idiopathic Skeletal Hyperostosis (DISH) with Trans-Discal Fracture at L2-L3
- Background:
- Association between DISH and spinal fractures is uncommon but has a high morbidity. These fractures can occur after minor trauma.
- The two types of spinal fractures usually seen are:
- Fractures through the mid-vertebral body above or below the attachment sites of flowing ossifications
- Fracture at the end of an ankylosed segment causing disruption of the disc space
- Clinical Presentation:
- Patients may present with history of minor trauma followed by various degrees of back pain.
- Key Diagnostic Features:
- Flowing ossification of 4 or more contiguous vertebral bodies, with increased thickness of the anterior longitudinal ligament
- There is usually minimal associated disc degeneration with disc height preservation, and no ankylosis of the facet joints
- Acute fractures in DISH involving the disc manifest as linear disc space T2 hyperintensity, +/- vertebral endplate avulsions. Fractures may extend into posterior elements.
- Differential Diagnosis:
- Ankylosing spondylosis with associated fracture, usually in younger patients. There is bilateral sacroileitis and erosive changes in the facet joints. Anderson and Romanus lesions are seen in the endplates.
- Treatment:
- Early stabilization of the fractured spine is needed. Operative stabilization is usually required for displaced or unstable fractures.
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