Surgical outcomes of open and percutaneous fixation for hyperextension DISH injuries in the intact patient, AO Classification B3N0-1M2

Introduction: Several studies report case series on ankylosing conditions including with differences in diffuse idiopathic hyperostosis (DISH). We report the longest case series with unified AO spine classification B3N0-1M2 in patients with ankylosing conditions modified DISH injuries. Given the comorbid status of those who incur hyperextension injuries with DISH, we analyze the role of intraoperative hypotension in complication rate and outcome.

Methods: From 2021 to 2024, patients with B2N0M2 injuries were tracked at our Level 1 Trauma Center. Complications were assessed until inpatient discharge and follow-up up to two months postoperatively. Postoperative imaging were assessed with standing x-rays.

Results: A total of 32 patients with hyperextension B3N0-1M2 injuries were identified from 2021-2024. Open fixation technique was used in 21 of 32 (65%) versus 11 cases treated with percutaneous methods. Obesity was observed in 22 of 32 (69%) patients, 18 of 32 (56%) had diabetes, and 11 of 32 (34%) had history of tobacco use. Two instances of postoperative UTI, one instance of pneumonia, and one case of bacteremia were identified in patients who received open fixation. Postoperative imaging demonstrated appropriate alignment, no hardware failures or evidence of proximal junctional or distal junctional kyphosis.

Conclusion : Open and percutaneous fixation for B3N0-1M2 fracture patterns demonstrate similar radiographic assessments within 2 months follow-up. No reoperations and no surgical site infections were observed. Urinary tract infections, pneumonia, and bacteremia complications were identified after open fixation methods.