Spinal cord injury without radiographic abnormality with diffuse idiopathic skeletal hyperostosis: A case report

Spinal cord injury without fracture dislocation (SCIWORA) is relatively rare, and spastic paralysis for more than 2 months with Diffuse diopathic skeletal hyperoseosis (DISH) is even rarer.

A 70-year-old male patient presented with quadriplegia for more than 2 months after a fall. He's incontinent of stool and urine. An MRI was performed and the diagnosis was "SCIWORA, DISH". After surgical treatment, there was a significant recovery of postoperative related symptoms.

The timing of SCIWORA surgery remains controversial, with most studies suggesting that early surgery (within 24 h) is more effective. Anterior cervical discectomy and fusion (ACDF) is one of the main surgical procedures that directly and completely removes compression from the anterior aspect of the spinal cord. Patients with SCIWORA combined with DISH may have fractures due to low-energy injuries and should be treated aggressively with surgery to avoid secondary injury to the spinal cord.

Adult SCIWORA patients should be aggressively treated surgically when vital signs are stable and relatively calm. To avoid secondary injury, titanium plates combined with self-stabilizing fusions provide reliable immediate stabilization and can be used as one of the internal fixation modalities.