European review for medical and pharmacological sciences · 2014
PET-CT diagnosis of cardiac cavernous hemangioma with large pericardial effusion.
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Maggi Stefania, Siviero Paola, Gonnelli Stefano, Caffarelli Carla, Gandolini Giorgio, Cisari Carlo, Rossini Maurizio, Iolascon Giovanni, Mauro Giulia Letizia, Nuti Ranuccio, Crepaldi Gaetano, Break Study Group
Аннотация
BACKGROUND: A vertebral fracture in a patient with diffuse idiopathic skeletal hyperostosis (DISH) is unstable due to larger moment via the long lever arm of an ankylosed spine. Therefore, surgical treatment is commonly recommended to avoid complications of nonunion and paralysis. In this report, we present 3 cases of vertebral fractures related to DISH which were primarily forced to undertake conservative treatment because of medical comorbidities and advanced age. CASE 1: A 93-year-old woman suffered from T10 vertebral fracture by a ground-level fall on her back. A trunk cast for 6 weeks was followed by brace wear for 3 months with administration of daily teriparatide. Then complete bone union was confirmed at 2 years after injury without back pain. CASE 2: An 84-year-old man suffered from T12 vertebral fracture by a fall on his back from a chair. A trunk cast for 12 weeks was followed by brace wear for 6 months with administration of daily teriparatide. Then acceptable bone union was confirmed at 1 year after the injury, and activities of daily living became independent. CASE 3: An 87-year-old woman suffered from T10 vertebral fracture due to a ground-level fall on her back when doing pruning work. Conservative treatment by trunk cast was first initiated with administration of daily teriparatide. However, delayed paralysis developed at 2 weeks after casting, so minimally invasive spinal stabilization (MISt) was performed. Bone union was obtained at 1 year after the injury without any neurological impairment.
CONCLUSIONS: Favorable clinical courses have been obtained in 2 cases, whereas MISt was required for delayed paralysis in 1 case. Although surgical stabilization is the first-line treatment for vertebral fracture with DISH, conservative treatment can also be one of the options in cases with high operative risk due to serious medical comorbidities. However, during conservative treatment, cautious observation is necessary not to overlook the occurrence of paralysis.
LEVEL OF EVIDENCE: 4.
CLINICAL RELEVANCE: Conservative treatment for vertebral fracture with DISH can be one of the options in cases with high operative risk due to serious medical comorbidities.
CONCLUSIONS: Favorable clinical courses have been obtained in 2 cases, whereas MISt was required for delayed paralysis in 1 case. Although surgical stabilization is the first-line treatment for vertebral fracture with DISH, conservative treatment can also be one of the options in cases with high operative risk due to serious medical comorbidities. However, during conservative treatment, cautious observation is necessary not to overlook the occurrence of paralysis.
LEVEL OF EVIDENCE: 4.
CLINICAL RELEVANCE: Conservative treatment for vertebral fracture with DISH can be one of the options in cases with high operative risk due to serious medical comorbidities.