Systemic Conditions Flashcards
What is the definition of DISH?
◦ Flowing ossification along the antero-lateral aspect of at least 4 contiguous vertebrae
Preservation of disk height
Absence of facet-joint ankylosis; absence of SI joint erosion, sclerosis or intraarticular osseous fusion
Epidemiology of DISH
overall incidence 6-12%
uncommon before 50 years old
Prevelence
> 50 y.o. (25% males; 15% females)
> 80 y.o. (28% males; 26% females)
less common in Black, Native-American and Asian populations
occurs anywhere in spinemost common in the thoracic spine (right side) > cervical > lumbar
postulated to be due to the protective effect of the pulsatile aorta on the left of the thoracic spine
symmetrical in the cervical and lumbar spine (syndesmophytes both on left and right of the spine)
What are DISH’s risk factors?
Gout
Hyper-lipidemia
Diabetes
Mortality rate of DISH after cervical spine trauma?
◦ for cervical spine trauma in DISH
15% for those treated operatively
67% for those treated nonoperatively
higher mortality rates than cervical spine trauma with ankylosing spondylitis
similar mortality rates to patients with ankylosing spondylitis overall
What are DISH patients at increased risk of developing after surgery?
HO
▪ 30-50% for THA in patients with DISH
<20% for THA in patients without DISH
Differene between DISH and AS
AS:
- Enthesitis, Bone erosion, Disc involvement
What type of spine fracture with AS
Extension type fracture that involves all 3 columns
Surgical treatment of chin on chest deformity
- C7-T1 cervico-thoracic osteotomy
advantage of C7-T1 osteotomy include
vertebral artery is external to transverse foremen
larger canal diameter
increased risk of venous air embolus (VAE) in the sitting operative position
Treatment of sacral insuffisency Fracture?
treatment is usually observation, with operative treatment reserved for those who fail nonoperative treatment
