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The Management of Spinal Injuries in Patients With Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis: A Comparison of Treatment Methods and Clinical Outcomes

Whang, Peter G. MD*; Goldberg, Grigory MD; Lawrence, James P. MD; Hong, Joseph BS; Harrop, James S. MD† ‡; Anderson, David Greg MD† ‡; Albert, Todd J. MD† ‡; Vaccaro, Alexander R. MD† ‡

doi: 10.1097/BSD.0b013e3181679bcb
Original Articles

Study Design A retrospective review of 12 patients with ankylosing spondylitis (AS) and 18 patients with diffuse idiopathic skeletal hyperostosis (DISH) treated at a single institution for spinal injuries between the years 2000 and 2006.

Objective To independently evaluate patients with these diagnoses who sustained spinal injuries and directly compare their treatment methods and clinical outcomes.

Summary of Background Data AS and DISH are disorders characterized by abnormal ossification of the spinal column, which predisposes these patients to spinal injuries with potentially devastating consequences.

Methods Patient and surgical data were obtained from medical records and appropriate imaging studies. Neurologic status was recorded using the American Spinal Injury Association (ASIA) impairment scale for spinal cord injuries, and clinical outcomes were assessed using Odom criteria.

Results Most of these injuries involved the subaxial cervical spine between C5 and C7. In all, 41.2% of AS patients were considered to be ASIA A, whereas 44.4% of DISH patients were classified as ASIA E. Surgery was performed in 83.3% of AS patients and 66.7% of DISH patients, and the overall complication rates were 41.7% and 33.3%, respectively. There were no statistically significant differences between the survivorship and outcomes of the AS and DISH groups and 81.3% of all respondents were classified as having excellent or good outcomes. There were 4 deaths, all of which were considered to be related to the use of halo-vest immobilization.

Conclusions Although the rate of neurologic injury was high for both groups, AS patients were more likely to exhibit neurologic deficits and undergo operative management. Although the majority of these spinal injuries were treated surgically, stable fractures without any associated neurologic deficits were often successfully managed with immobilization. Complications were observed with both operative and nonoperative treatments, although all of the deaths occurred in conjunction with the use of the halo-vest orthosis.

*Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT

Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute

Department of Neurologic Surgery, Thomas Jefferson University, Philadelphia, PA

This study did not involve any external sources of funding or support.

Reprints: Peter G. Whang, MD, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208130, New Haven, CT 06520-8170 (e-mail:

Received for publication August 26, 2007; accepted January 5, 2008

© 2009 Lippincott Williams & Wilkins, Inc.