Posterior Percutaneous Screw Fixation to Treat Vertebral Fracture Non-union in Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) alters the biomechanical properties of the spine, rendering it highly prone to fracture, following even minor trauma. Risk of delayed diagnosis of vertebral fractures is particularly high in this cohort of patients since radiographs are notoriously difficult to interpret and presentation is late, due to difficulty distinguishing new from pre-existing back pain. Our case describes a gentleman in his late sixties with a six-month delay in presentation to our services with a T12 fracture, secondary to previously undiagnosed DISH, which had progressed to non-union. He underwent T9-L3 thoracolumbar posterior percutaneous stabilisation and fusion. At eighteen months follow-up, there was evidence of union, significant improvement in his pain, no focal neurology signs, and the patient had returned to his activities of daily living (ADLs).