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

Jaedong Kim; Jaewon Lee; Ye-Soo Park

doi:10.4184/jkss.2017.24.2.103

Journal List > J Korean Soc Spine Surg > v.24(2) > 1076128

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Kim, Lee, and Park: Kyphotic Deformity after Spinal Fusion in a Patient with Diffuse Idiopathic Skeletal Hyperostosis - A Case Report -

Case Report

Journal of Korean Spine Surg 2017;24(2):103-108.

Published online: 30 June 2017

DOI: https://doi.org/10.4184/jkss.2017.24.2.103

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

Jaedong Kim, M.D., Jaewon Lee, M.D., Ye-Soo Park, M.D.

Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea

Corresponding author: Ye-Soo Park, M.D. ORCID ID: 0000-0002-2801-2674 Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Korea TEL: +82-31-560-2317, FAX: +82-31-557-8781 E-mail: hyparkys@hanyang.ac.kr

Received 5 November 201630 December 2016 Accepted 25 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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.

Keywords: Diffuse idiopathic skeletal hyperostosis (DISH), Kyphotic deformity

REFERENCES

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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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