{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T23:50:38Z","timestamp":1784159438388,"version":"3.55.0"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Extension fractures in the setting of diffuse idiopathic skeletal hyperostosis (DISH) represent highly unstable injuries. As a result, these fractures are most frequently treated with immediate surgical fixation to limit any potential risk of associated neurological injury. Although this represents the standard of care, patients with significant comorbidities, advanced age, or medical instability may not be surgical candidates. In this paper, the authors evaluated a series of patients with extension DISH fractures who were treated with orthosis alone and evaluated their outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective review from 2015 to 2022 was conducted at a large level 1 trauma center. Patients with extension-type DISH fractures without neurological deficits were identified. All patients were treated conservatively with orthosis alone. Baseline patient characteristics and adverse outcomes are reported.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Twenty-seven patients were identified as presenting with extension fractures associated with DISH without neurological deficit. Of these, 22 patients had complete follow-up on final chart review. Of these 22 patients, 21 (95.5%) were treated successfully with external orthosis. One patient (4.5%) who was noncompliant with the brace had an acute spinal cord injury 1 month after presentation, requiring immediate surgical fixation and decompression. No other complications, including skin breakdown or pressure ulcers related to bracing, were reported.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Treatment of extension-type DISH fractures may be a reasonable option for patients who are not candidates for safe surgical intervention; however, a risk of neurological injury secondary to delayed instability remains, particularly if patients are noncompliant with the bracing regimen. This risk should be balanced against the high complication rate and potential mortality associated with surgical intervention in this patient population.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.6.spine22551","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T09:02:39Z","timestamp":1659690159000},"page":"927-931","source":"Crossref","is-referenced-by-count":5,"title":["Outcomes following conservative treatment of extension fractures in the setting of diffuse idiopathic skeletal hyperostosis: is external orthosis alone a reasonable option?"],"prefix":"10.3171","volume":"37","author":[{"given":"Paul S.","family":"Page","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garret P.","family":"Greeneway","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendell B.","family":"Lake","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel P.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darnell T.","family":"Josiah","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amgad S.","family":"Hanna","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel K.","family":"Resnick","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Nat Rev Rheumatol","first-page":"741","article-title":"Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms","volume":"9","author":"Mader R","year":"2013","unstructured":"Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013;9(12):741\u2013750.24189840"},{"issue":"3","key":"b2","series-title":"Radiology","first-page":"513","article-title":"Diffuse idiopathic skeletal hyperostosis (DISH): Forestier\u2019s disease with extraspinal manifestations","volume":"115","author":"Resnick D","year":"1975","unstructured":"Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier\u2019s disease with extraspinal manifestations. Radiology. 1975;115(3):513\u2013524.1129458"},{"issue":"4","key":"b3","series-title":"Ann Rheum Dis","first-page":"321","article-title":"Senile ankylosing hyperostosis of the spine","volume":"9","author":"Forestier J","year":"1950","unstructured":"Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. 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Acta Chir Orthop Traumatol Cech","first-page":"335","article-title":"Type AO\/ASIF B3 fractures of the thoracic and lumbar spine","volume":"80","author":"Mat\u011bjka J","year":"2013","unstructured":"Mat\u011bjka J, Sk\u00e1la-Rosenbaum J, Krbec M, Zeman J, Mat\u011bjka T, Zeman P. Type AO\/ASIF B3 fractures of the thoracic and lumbar spine. Article in Czech. Acta Chir Orthop Traumatol Cech. 2013;80(5):335\u2013340.25105674"},{"issue":"20","key":"b7","series-title":"J Neurosurg Case Lessons","first-page":"CASE21689","article-title":"Spinal fractures in the setting of diffuse idiopathic skeletal hyperostosis conservatively treated via orthosis: illustrative cases","volume":"3","author":"Taher AW","year":"2022","unstructured":"Taher AW, Page PS, Greeneway GP,  Spinal fractures in the setting of diffuse idiopathic skeletal hyperostosis conservatively treated via orthosis: illustrative cases. 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