{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:46:41Z","timestamp":1782262001152,"version":"3.54.5"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"25","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,6,22]]},"abstract":"\n BACKGROUND<\/jats:title>\n Diffuse idiopathic skeletal hyperostosis (DISH) limits spinal mobility, predisposing patients to unstable fractures even following minor trauma. While spinal fractures are a well-documented complication, massive hemothorax remains a rare presentation, particularly when the bleeding source is from the osteophyte fracture site.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n An 84-year-old man with DISH, currently on a factor Xa inhibitor, presented after a 2-m fall. Initial imaging revealed a T11 reverse Chance-type fracture and a right hemothorax, notably without associated rib fractures or pulmonary contusions. Over the next 10 hours, chest tube drainage precipitously increased to more than 2400 mL, prompting emergency video-assisted thoracoscopic surgery. Exploration revealed no active bleeding at the primary T11 injury. Instead, the hemorrhage originated from an isolated, occult osteophyte fracture at T7\u20138. Hemostasis was successfully achieved with electrocautery, human thrombin, and fibrin glue, followed by delayed posterior spinal fusion.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n In patients with DISH, life-threatening hemothorax can arise from occult osteophyte fractures situated far from the spinal injury diagnosed at initial presentation. When bleeding is continuous or progressive, clinicians must maintain a high index of suspicion for remote bleeding sources. Surgical intervention should be considered for hemostasis, especially in the setting of concurrent anticoagulation therapy.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE26279<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case26279","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:01:00Z","timestamp":1782259260000},"source":"Crossref","is-referenced-by-count":0,"title":["Occult osteophyte fracture as an atypical source of massive hemothorax in diffuse idiopathic skeletal hyperostosis: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8795-109X","authenticated-orcid":true,"given":"Daiki","family":"Nakajima","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima"},{"name":"Department of Orthopedics, Kochi Red Cross Hospital, Kochi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichiro","family":"Kita","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Kochi Red Cross Hospital, Kochi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Kochi Red Cross Hospital, Kochi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Goda","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Kochi Red Cross Hospital, Kochi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadashi","family":"Uchida","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Kochi Red Cross Hospital, Kochi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiharu","family":"Sogo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Kochi Red Cross Hospital, Kochi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Sairyo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Radiology","first-page":"559","article-title":"Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH)","volume":"119","author":"Resnick","year":"1976","unstructured":"Resnick DNiwayama G.Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 1976;119(3):559-568. doi:10.1148\/119.3.559"},{"issue":"1","key":"bib2","series-title":"Int J Spine Surg","first-page":"195","article-title":"Clinical results of vertebral fracture related to diffuse idiopathic skeletal hyperostosis (DISH) which underwent conservative treatment: three case reports","volume":"15","author":"Kuroki","year":"2021","unstructured":"Kuroki HHiga KChosa E.Clinical results of vertebral fracture related to diffuse idiopathic skeletal hyperostosis (DISH) which underwent conservative treatment: three case reports. Int J Spine Surg. 2021;15(1):195-202. doi:10.14444\/8025"},{"issue":"3","key":"bib3","series-title":"Spine Surg Relat Res","first-page":"274","article-title":"A case of ankylosing spinal hyperostosis with massive hemothorax due to thoracic vertebral fracture caused by minor trauma","volume":"3","author":"Hirota","year":"2019","unstructured":"Hirota RIrifune HTakahashi NA case of ankylosing spinal hyperostosis with massive hemothorax due to thoracic vertebral fracture caused by minor trauma. Spine Surg Relat Res. 2019;3(3):274-276. doi:10.22603\/ssrr.2018-0049"},{"issue":"5","key":"bib4","series-title":"Spine Surg Relat Res","first-page":"464","article-title":"Incidence and predictive factors of massive hemothorax due to thoracic vertebral fractures","volume":"6","author":"Takami","year":"2022","unstructured":"Takami MIwasaki YOkada MIncidence and predictive factors of massive hemothorax due to thoracic vertebral fractures. Spine Surg Relat Res. 2022;6(5):464-471. doi:10.22603\/ssrr.2022-0001"},{"issue":"1","key":"bib5","series-title":"Eur J Cardiothorac Surg","first-page":"133","article-title":"A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management","volume":"24","author":"Sirmali","year":"2003","unstructured":"Sirmali MT\u00fcr\u00fct HTop\u00e7u S.A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 2003;24(1):133-138. doi:10.1016\/s1010-7940(03)00256-2"},{"issue":"C","key":"bib6","series-title":"Int J Surg Case Rep","first-page":"133","article-title":"Delayed massive hemothorax due to diaphragm injury with rib fracture: a case report","volume":"77","author":"Muronoi","year":"2020","unstructured":"Muronoi TKidani AOka KDelayed massive hemothorax due to diaphragm injury with rib fracture: a case report. Int J Surg Case Rep. 2020;77(C):133-137. doi:10.1016\/j.ijscr.2020.10.125"},{"issue":"1","key":"bib7","series-title":"J Med Case Rep","first-page":"291","article-title":"Massive hemothorax due to two bleeding sources with minor injury mechanism: a case report","volume":"12","author":"Ota","year":"2018","unstructured":"Ota KFumimoto SIida RMassive hemothorax due to two bleeding sources with minor injury mechanism: a case report. J Med Case Rep. 2018;12(1):291. doi:10.1186\/s13256-018-1813-x"},{"issue":"4","key":"bib8","series-title":"Cureus","first-page":"e58422","article-title":"A case of traumatic hemothorax from an isolated thoracic vertebral fracture in an elderly patient on combined anticoagulant and antiplatelet therapy","volume":"16","author":"Yuhara","year":"2024","unstructured":"Yuhara SKohno T.A case of traumatic hemothorax from an isolated thoracic vertebral fracture in an elderly patient on combined anticoagulant and antiplatelet therapy. 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Spine Surg Relat Res. 2022;6(5):464-471. doi:10.22603\/ssrr.2022-0001"},{"issue":"1","key":"bib5","series-title":"Eur J Cardiothorac Surg","first-page":"133","article-title":"A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management","volume":"24","author":"Sirmali","year":"2003","unstructured":"Sirmali MT\u00fcr\u00fct HTop\u00e7u S.A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 2003;24(1):133-138. doi:10.1016\/s1010-7940(03)00256-2"},{"issue":"C","key":"bib6","series-title":"Int J Surg Case Rep","first-page":"133","article-title":"Delayed massive hemothorax due to diaphragm injury with rib fracture: a case report","volume":"77","author":"Muronoi","year":"2020","unstructured":"Muronoi TKidani AOka KDelayed massive hemothorax due to diaphragm injury with rib fracture: a case report. Int J Surg Case Rep. 2020;77(C):133-137. doi:10.1016\/j.ijscr.2020.10.125"},{"issue":"1","key":"bib7","series-title":"J Med Case Rep","first-page":"291","article-title":"Massive hemothorax due to two bleeding sources with minor injury mechanism: a case report","volume":"12","author":"Ota","year":"2018","unstructured":"Ota KFumimoto SIida RMassive hemothorax due to two bleeding sources with minor injury mechanism: a case report. J Med Case Rep. 2018;12(1):291. doi:10.1186\/s13256-018-1813-x"},{"issue":"4","key":"bib8","series-title":"Cureus","first-page":"e58422","article-title":"A case of traumatic hemothorax from an isolated thoracic vertebral fracture in an elderly patient on combined anticoagulant and antiplatelet therapy","volume":"16","author":"Yuhara","year":"2024","unstructured":"Yuhara SKohno T.A case of traumatic hemothorax from an isolated thoracic vertebral fracture in an elderly patient on combined anticoagulant and antiplatelet therapy. 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J Orthop Trauma. 2017;31(4):S57-S74. doi:10.1097\/BOT.0000000000000953"},{"issue":"11","key":"bib11","series-title":"Spine (Phila Pa 1976)","first-page":"E458","article-title":"Spine fractures in patients with ankylosing spinal disorders","volume":"35","author":"Caron","year":"2010","unstructured":"Caron TBransford RNguyen QAgel JChapman JBellabarba C.Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010;35(11):E458-E464. doi:10.1097\/BRS.0b013e3181cc764f"},{"key":"bib12","series-title":"Case Rep Radiol","first-page":"1","article-title":"Haemothorax and thoracic spine fractures in the elderly","volume":"2012","author":"Masteller","year":"2012","unstructured":"Masteller MAChauhan AMusunuru HWalsh MMBoyer BPrahlow JA.Haemothorax and thoracic spine fractures in the elderly. 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Ann Card Anaesth. 2025;28(1):76-79. doi:10.4103\/aca.aca_135_24"},{"issue":"3","key":"bib15","series-title":"Lung India","first-page":"283","article-title":"Spontaneous massive hemopneumothorax: double trouble with a twist","volume":"34","author":"Kuriakose","year":"2017","unstructured":"Kuriakose MKhanna ATalwar D.Spontaneous massive hemopneumothorax: double trouble with a twist. Lung India. 2017;34(3):283-286. doi:10.4103\/lungindia.lungindia_6_16"},{"key":"bib16","series-title":"VATS","first-page":"8","article-title":"Video-assisted thoracoscopic surgery (VATS) in trauma: a narrative review","volume":"9","author":"Duggan","year":"2024","unstructured":"Duggan JRodriguez GPeters AAntevil JTrachiotis G.Video-assisted thoracoscopic surgery (VATS) in trauma: a narrative review. 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