Surgical treatment with vertebral body stenting and posterior fixation using instrumentation between the one–above and one–below vertebral levels for lumbar vertebral fracture with diffuse idiopathic skeletal hyperostosis: A case report

<p>Introduction: Diffuse idiopathic skeletal hyperostosis (DISH) is a con­di­tion in which minor trauma can cause unstable vertebral fractures. Because conservative treatment, such as bed rest and bracing, may cause nonunion and delayed paralysis, surgical treatment, such as long posterior fixation using instrumentation between at least the three–above and three–below vertebral levels, is recommended. However, long posterior fixation is unsuitable in patients with high operative risks due to serious medical comorbidities or an advanced age. We herein report a case of lumbar reverse chance fracture treated with vertebral body stenting (VBS) and short posterior fixation.</p><p>Case report: A 96–year–old woman was admitted to our hospital for cerebral infarction presenting with severe left hemiparesis. On ad­mis­sion, radiological examinations revealed no fresh vertebral fracture but did note an old vertebral fracture at the Th12 and L5 levels with DISH and severe kyphosis. However, she complained of back pain seven days after admission without any obvious history of trauma. Radiological examinations revealed fresh reverse chance fracture at the L2 level. Although conservative treatment was administrated, there was no marked improvement in the symptom. She continued to suffer from severe back pain. We performed VBS and posterior fixation using instrumentation between the one–above and one–below vertebral levels because of the patient’s advanced age and severe kyphosis. Her severe back pain improved immediately after the procedure. Follow–up computed tomography at six months post­operatively revealed bony fusion between the fractured ends.</p><p>Conclusion: Vertebral fractures with DISH are often challenging for spinal surgeons and patients. It is important that the treatment strat­egy be considered on a case–by–case bias, especially in patients with advanced age. Less invasive surgery as was performed in this case may be a viable option in similar patients.</p>