Risk factors for delayed diagnosis of spinal fracture associated with diffuse idiopathic skeletal hyperostosis: A nationwide multiinstitution survey.

Aged Aged, 80 and over Delayed Diagnosis Diagnostic Imaging Female Humans Hyperostosis, Diffuse Idiopathic Skeletal / diagnosis Male Middle Aged Risk Factors Spinal Fractures / diagnostic imaging

Journal

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
ISSN: 1436-2023
Titre abrégé: J Orthop Sci
Pays: Japan
ID NLM: 9604934

Informations de publication

Date de publication:
Nov 2021
Historique:
received: 12 05 2020
revised: 07 10 2020
accepted: 09 10 2020
pubmed: 19 12 2020
medline: 11 11 2021
entrez: 18 12 2020
Statut: ppublish

Résumé

Patients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH). The subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made >24 h after injury. Main causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p < 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P < 0.05) and Frankel grade E at the time of injury (OR 2.29; P < 0.01) were significantly associated with delayed diagnosis. In patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration.

Sections du résumé

BACKGROUND BACKGROUND
Patients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH).
METHODS METHODS
The subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made >24 h after injury.
RESULTS RESULTS
Main causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p < 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P < 0.05) and Frankel grade E at the time of injury (OR 2.29; P < 0.01) were significantly associated with delayed diagnosis.
CONCLUSION CONCLUSIONS
In patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration.

Identifiants

DOI: 10.1016/j.jos.2020.10.019 PMID: 33334624
pubmed: 33334624
pii: S0949-2658(20)30334-1
doi: 10.1016/j.jos.2020.10.019
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

968-973

Informations de copyright

Copyright © 2020. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of competing interest Kazuyoshi Kobayashi, Eijiro Okada, Toshitaka Yoshii, Mikito Tsushima, Tsuyoshi Yamada, Kei Watanabe, Keiichi Katsumi, Hiroyuki Katoh, Akihiko Hiyama, Masahiko Watanabe, Yukihiro Nakagawa, Motohiro Okada, Teruaki Endo, Yasuyuki Shiraishi, Kazuhiro Takeuchi, Shunji Matsunaga, Keishi Maruo, Kenichiro Sakai, Sho Kobayashi, Tetsuro Ohba, Kanichiro Wada, Junichi Ohya, Kanji Mori, Hirosuke Nishimura, Takashi Tsuji, Kota Watanabe, Atsushi Okawa, Morio Matsumoto, and Shiro Imagama were received a Japanese Health Labor Sciences Research Grant No.038. Tsuyoshi Yamada, Akihiko Hiyama, Hiroyuki Katoh, Yasuyuki Shiraishi, Kazuhiro Takeuchi, Kenichiro Sakai, Kanichiro Wada, Kota Watanabe, and Morio Matsumoto were received a Japan Agency for Medical Research and DevelopmentJP15ek0109136.

Auteurs

Kazuyoshi Kobayashi (K)

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan; Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan.

Eijiro Okada (E)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.

Toshitaka Yoshii (T)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan.

Mikito Tsushima (M)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, 455-8530, Aichi, Japan.

Tsuyoshi Yamada (T)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan.

Kei Watanabe (K)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata-shi, 951-8510, Niigata, Japan.

Keiichi Katsumi (K)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata-shi, 951-8510, Niigata, Japan.

Akihiko Hiyama (A)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan.

Hiroyuki Katoh (H)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan.

Masahiko Watanabe (M)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan.

Yukihiro Nakagawa (Y)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, 649-7113, Wakayama, Japan.

Motohiro Okada (M)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Wakayama, Japan.

Teruaki Endo (T)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, 329-0498, Tochigi, Japan.

Yasuyuki Shiraishi (Y)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, 329-0498, Tochigi, Japan.

Kazuhiro Takeuchi (K)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita Ward, Okayama, 701-1192, Okayama, Japan.

Shunji Matsunaga (S)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuocho, 892-8502, Kagoshima, Japan.

Keishi Maruo (K)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, 663-8501, Hyogo, Japan.

Kenichiro Sakai (K)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, 332-8558, Saitama, Japan.

Sho Kobayashi (S)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Higashi Ward, Hamamatsu, 432-8580, Shizuoka, Japan.

Tetsuro Ohba (T)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-shi, 409-3898, Yamanashi, Japan.

Kanichiro Wada (K)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, 036-8562, Aomori, Japan.

Junichi Ohya (J)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.

Kanji Mori (K)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan.

Hirosuke Nishimura (H)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, 160-8402, Tokyo, Japan.

Takashi Tsuji (T)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, 152-8902, Tokyo, Japan.

Kota Watanabe (K)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.

Atsushi Okawa (A)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan.

Morio Matsumoto (M)

Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.

Shiro Imagama (S)

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan; Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan. Electronic address: imagama@med.nagoya-u.ac.jp.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Risk factors for delayed diagnosis of spinal...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Risk factors for delayed diagnosis of spinal...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Retard de diagnostic › Risk factors for delayed diagnosis of spinal...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Risk factors for delayed diagnosis of spinal...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Risk factors for delayed diagnosis of spinal...
questionsmedicales.fr › Maladies ostéomusculaires › Maladies osseuses › Maladies du rachis › Ostéophytose vertébrale › Hyperostose vertébrale ankylosante › Risk factors for delayed diagnosis of spinal...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Risk factors for delayed diagnosis of spinal...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Risk factors for delayed diagnosis of spinal...
questionsmedicales.fr › Plaies et blessures › Fractures osseuses › Fractures du rachis › Risk factors for delayed diagnosis of spinal...