P140. Delayed diagnosis impacted on delayed paralysis in spinal fractures with diffuse idiopathic skeletal hyperostosis: prospective nationwide study

Abstract

BACKGROUND CONTEXT Diffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. The patients with DISH spinal fractures often complained minimal symptoms, which may lead to delayed diagnosis. PURPOSE This prospective study was conducted to evaluate the association between delayed diagnosis and delayed paralysis in DISH spinal injury. STUDY DESIGN/SETTING The study design was prospective multicenter study. Twelve institusions participated into this study. PATIENT SAMPLE This study included 69 patients with DISH (44 males, 25 females; mean age 75.2±11.4years). OUTCOME MEASURES Delayed diagnosis, dates of medical presentation, dates for correct diagnosis, name of diagnosis, neurological status at injury (Frankel grade), and delayed paralysis were evaluated. METHODS Patients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. RESULTS Delayed diagnosis was observed in 55.1% of the subjects. The reason of delayed diagnosis was doctor's delay in 55.3% and patient's delay in 44.7%. All patients without delayed diagnosis were made correct diagnosis by first medical institution within 24 hours after injury, however, patients with delayed diagnosis spent 11.3 days (0-180 days). Before correct diagnosis, 19 different diagnosis was made, osteoporotic vertebral fracture (57.9%) was the most frequent diagnosis. At the time of injury, Frankel B was observed in 2.9%, C in 7.2%, D in 15.9%, E in 73.9%, respectively. Delayed paralysis was observed in 17.2%. Correct diagnosis within 14 days after injury significantly associated with delayed paralysis (p=.049). CONCLUSIONS Delayed diagnosis was observed more than 50% of the patients, and most reason was doctor's delay (55.3%). To avoid delayed paralysis and improve clinical symptom, correct diagnosis at initial presentation is essential. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.