Abstract
With the advancement of cancer treatment and minimally invasive surgery, the indications for surgery for metastatic spinal tumors are expanding. Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory skeletal disease characterized by calcification and ossification of ligaments and entheses. In Japan, the prevalence of DISH is increasing with its superaging society. The purpose of this article is to report a case of applying a novel screw technique for pathological fracture in a patient with DISH and spinal metastasis. An 80-year-old man with spinal metastasis presented with acute onset of severe back pain, and investigations revealed a fracture of a metastatic lesion in T10–T12 in the range of DISH. We performed posterior fixation with a percutaneous pedicle screw system using a penetrating endplate technique. The patient's back pain improved, and he was able to mobilize with minimal assistance and survived for 8 months with a good quality of life. Spinal fracture accompanied by DISH sometimes occurs with severe instability because of injury across 3-column injury and its long lever arm. Spinal instability neoplastic score indicates instability of pathological fractures of spinal metastases but needs to be evaluated carefully when DISH is present. The prevalence of DISH is increasing in the elderly, and penetrating endplate screws can be an effective option in posterior fusion surgery for patients with DISH and spinal metastases.
Highlights
Surgical treatment of spinal metastases is largely palliative
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory skeletal disease characterized by calcification and ossification of ligaments and entheses [3]
Rapid progress has been made in the treatment of malignant tumors, and with the development of anticancer drugs, widespread use of tumortargeted therapy, and the advent of molecular-targeted drugs, patients with cancers who were previously expected to have a prognosis of only a few months once metastasis to the spine was confirmed can be expected to survive for years [1, 2]
Summary
Surgical treatment of spinal metastases is largely palliative. With the advancement of cancer treatment and minimally invasive surgery, the indications for surgery for metastatic spinal tumors are expanding [2]. Spine surgery is increasingly being performed for spinal metastasis in older patients. For spine surgery in the elderly, there is a discrepancy between less-invasive surgery and the acquisition of fixation strength, which can cause difficulties in deciding surgical methods. Several studies reported the efficacy of a transdiscal screw technique with its strong fixing force for some instances of lumbar degenerative disease [10–15]. DISHrelated fractures are a suitable indication for transdiscal screws because bony fused segments do not have flexibility or disc function. We have applied a transdiscal “penetrating endplate screw (PES) technique” to fix thoracolumbar DISH-related fractures in patients with spinal metastasis
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