Thoracolumbar Spine Trauma Outcomes: Effect of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis

Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are chronic conditions associated with altered spine architecture that can potentially influence the outcomes of spine trauma. This study aims to compare demographic characteristics, clinical outcomes, and surgical interventions among thoracolumbar spine trauma patients with a concomitant diagnosis of AS or DISH with those with no underlying ankylosing spinal conditions. Our aim is to better understand how these diseases may affect the prognosis and treatment in the context of thoracolumbar spine trauma.

A retrospective analysis of patients presenting with thoracolumbar spine trauma at a single-level I trauma center between 2015 and 2024 was conducted (n = 189). The patients were categorized into three groups: those with AS (n = 20), those with DISH (n = 32), and those without either condition (n = 137). Primary outcomes included neurologic status at admission, neurologic outcomes, number of levels fused, postoperative complications, length of hospital stay, in-hospital mortality, and readmission rates.

Patients with AS and DISH were generally older (>70 years old) with more comorbidities such as diabetes and osteoporosis ( P < 0.001). Mechanisms of injury differed, with motor vehicle collisions more common in the control group and ground-level falls or falls from height being more frequent in patients with AS/DISH. Regarding trauma outcomes, no significant differences in neurologic status or improvement were observed, but patients with AS/DISH required more extensive surgical intervention and more levels fused ( P < 0.05). Postoperatively, patients in the AS/DISH groups had higher rates of long-term care admission and in-hospital mortality, although readmission rates and intensive care unit admissions were similar across groups.

Although their immediate postoperative outcomes are comparable with those of unaffected individuals, patients with AS and DISH required more extensive surgical interventions and had higher rates of long-term care admissions and in-hospital mortality. These findings underscore the need for tailored management strategies for spine trauma patients with AS and DISH.