J Korean Soc Spine Surg.  2017 Jun;24(2):103-108. 10.4184/jkss.2017.24.2.103.

Kyphotic Deformity after Spinal Fusion in a Patient with Diffuse Idiopathic Skeletal Hyperostosis: A Case Report

Affiliations
  • 1Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea. hyparkys@hanyang.ac.kr

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
To report a case of progressive kyphotic deformity after spinal fusion in a patient with diffuse idiopathic skeletal hyperostosis (DISH). SUMMARY OF LITERATURE REVIEW: DISH is characterized by spinal and peripheral enthesopathy, and is a completely different disease from ankylosing spondylitis (AS). Though DISH can be associated with thoracic kyphosis, no reports have described a progressive thoracolumbar kyphotic deformity after spinal fusion surgery in a DISH patient.
MATERIALS AND METHODS
A 47-year-old male presented with pain in the thoracolumbar region. After excluding the possibility of AS and confirming the diagnosis of DISH, we performed spinal fusion for the treatment of a T11-T12 flexion-distraction injury. The kyphotic deformity was found to be aggravated after the first operation, and we then performed corrective osteotomy and additional spinal fusion. Results: The kyphotic deformity of the patient was corrected after the second operation.
RESULTS
The kyphotic deformity of the patient was corrected after the second operation.
CONCLUSIONS
In DISH patients in whom AS must be excluded in the differential diagnosis, a kyphotic deformity can become aggravated despite spinal fusion surgery, so regular and continuous follow-up is required.

Keyword

Diffuse idiopathic skeletal hyperostosis (DISH); Kyphotic deformity

MeSH Terms

Congenital Abnormalities*
Diagnosis
Diagnosis, Differential
Follow-Up Studies
Humans
Hyperostosis, Diffuse Idiopathic Skeletal*
Kyphosis
Male
Middle Aged
Osteotomy
Rheumatic Diseases
Spinal Fusion*
Spondylitis, Ankylosing

Figure

  • Fig. 1. Preoperative radiographs. (A) Anteroposterior view of a thoracolumbar spine radiograph shows osteophytes connecting the thoracic vertebrae. (B) Lateral view of a thoracolumbar spine radiograph shows a ‘melted candle wax’ appearance. (C) An axial computed tomography image of the pelvis shows no evidence of fusion, erosion, or sclerosis of the sacroiliac joint.

  • Fig. 2. Preoperative CT and MRI. (A) Sagittal CT shows a fracture of the vertebral body of T11 and T12. (B) Sagittal CT (arrowheads) shows a fracture of the spinous process of T11. (C) Three-dimensional CT shows the fracture of the vertebral body of T11 and T12. (D) Sagittal MRI shows the fracture of the vertebral body and spinous process of T11 and the fracture of the vertebral body of T12. All the images indicate a T11-T12 flexion-distraction injury. CT, computed tomography; MRI, magnetic resonance imaging.

  • Fig. 3. (A) A radiograph taken 2 months after the first operation, showing a sagittal vertical axis (dashed line) of 8.6 mm and a thoracic kyphosis angle (solid line) of 49°. (B) A radiograph taken 2 years after the first operation, showing a sagittal vertical axis (dashed line) of 69.3 mm and a thoracic kyphosis angle (solid line) of 52° (C). A radiograph taken 2 months after the second operation, showing a sagittal vertical axis (dashed line) of 13.1 mm and a thoracic kyphosis angle (solid line) of 42°.


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