Findings
The initial MRI shows edema with a subtle fracture of the T11 vertebral body extending into the posterior elements. The subsequent MRI demonstrates a persistence and increased edema of the T11 body and posterior elements, anterior paraspinal edema/hematoma, and a progressive loss of the architecture of the T11 vertebrae. Seen well on the axial images of the MRI is the loss of CSF of the thecal sac/severe stenosis and severe right neural foraminal stenosis. The CT examination shows the loss of architecture of T11 from continued fracture and collapse. Well seen also is paravertebral osteophyte formation with bony bridging and bony bridging of the facet joints. There is an overall relative preservation of the disc spaces.
Diagnosis: DISH fragility fracture
DISH (diffuse idiopathic skeletal hyperostosis) is a bone forming process with paravertebral osteophytes giving bony bridging of multiple vertebrae (classically defined as 4 or more bridging vertebrae). Although not part of the original description, our experience is there is also often bony bridging across facet joints/posterior elements, portions of the sacroiliac joints, and prominent enthesopathic changes of both the axial and appendicular skeleton.
One of the know complications of DISH or other bone forming processes that yield ankylosis, such as ankylosing spondylitis, is that the ankylosed bone is brittle. This brittle bone has a predisposition to fracture even in low energy trauma such as a fall from a standing height. This can lead to pain and also areas of spinal stenosis. Both of these situations may at time require surgical intervention.
References
Netanja I. Harlianto, Solaiman Ezzafzafi, Wouter Foppen, Jonneke S. Kuperus, Irene E. van der Horst-Bruinsma, Pim A. de Jong, Jorrit-Jan Verlaan, The prevalence of vertebral fractures in diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: A systematic review and meta-analysis, North American Spine Society Journal (NASSJ), March, Volume 17, 2024.
Anaïs Guiot, Charline Estublier, Marine Gaude, Pawel Szulc, Roland Chapurlat, Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men, Rheumatology, Volume 60, Issue 5, May 2021, Pages 2197–2205.