Investigation of the Usefulness of Implants With Locking Mechanisms for Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Induced Thoracic and Lumbar Fractures in Patients Operated in the Prone Position.

Autor:	Watanabe S; Orthopaedics, Kawasaki Medical School, Kurashiki, JPN., Nakanishi K; Orthopaedics, Kawasaki Medical School, Kurashiki, JPN., Uchino K; Orthopaedics, Kawasaki Medical School, Kurashiki, JPN., Iba H; Orthopaedics, Kawasaki Medical School, Kurashiki, JPN., Sugimoto Y; Orthopaedics, Kawasaki Medical School, Kurashiki, JPN., Mitani S; Orthopaedics, Kawasaki Medical School, Kurashiki, JPN.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Aug 17; Vol. 16 (8), pp. e67071. Date of Electronic Publication: 2024 Aug 17 (Print Publication: 2024).
DOI:	10.7759/cureus.67071
Abstrakt:	Background Diffuse idiopathic skeletal hyperostosis (DISH) is a disease that causes bone growth in the spine and musculoskeletal system, and even minor trauma can cause fractures that often require surgery. DISH-induced fractures show a tendency for bone loss when operated in the prone position, which can lead to poor fusion and implant failure; therefore, surgery in the lateral recumbent position is often recommended. However, inserting a pedicle screw (PS) in the lateral recumbent position is technically difficult. This study examined the effectiveness of the repair and fixation of thoracic and lumbar spine fractures using implants with locking mechanisms in the prone position in patients with DISH. Methods We retrospectively analyzed the data from 11 patients (six males and five females; mean age: 87 years) who underwent surgery for thoracic and lumbar fractures caused by DISH between December 2023 and June 2024. Surgery was performed in the prone position using PSs or transdiscal screws (TSDs) for DISH. Ennovate® implants manufactured by B-BRAUN were used. The fixed range was three above-three below for PSs and two above-two below for TSDs. The evaluation parameters were the height/level of injury, operative time, blood loss, local kyphosis angle, anterior wall height ratio, and complications. The local kyphosis angle was measured as the angle between the upper and lower endplates of the fractured vertebrae. The ratio of the anterior wall height was evaluated. Results The average operative time was 87 min (52-172 min), and the average blood loss was 40ml (10-140 ml). The preoperative and postoperative local kyphosis angle was -8.7° and -2.4°, respectively, and the average local kyphosis angle improvement was 6.3° (0.1-14°). The preoperative and postoperative anterior wall height ratio was 132% and 110%, respectively, and the average anterior wall height ratio improvement was 22% (2-82%). No complications, such as screw deviation, implant loosening, loss of correction, or skin problems, were observed. Conclusion This study demonstrated that DISH-induced thoracic and lumbar spine fractures could be repaired and fixed using implants with locking mechanisms in the prone position. The prone position is familiar to spine surgeons and is considered safe. Additionally, screw migration may occur due to decreased bone density in the vertebral bodies with DISH; in such cases, it would be better to fix the screw without forcing it to be repositioned. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of Kawasaki Medical School issued approval 6481-00. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Watanabe et al.)
Databáze:	MEDLINE
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