Our family was involved in a car accident over the weekend. Turns out my elderly father who was with us has a condition we didn't know about called DISH. Now on top of that, he has a fractured skull and two fractures in the neck. He's headed into surgery right now. Please help us understand this condition. What are his chances for a complete recovery?
Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition in the spine caused by ligaments that turn into bone. Spinal ligaments along the front and back of the spine that help stabilize the spine are affected.
As a result of this condition the spine becomes stiff, rigid, and more fragile in the older adult. The older adult may just think these changes are part of the aging process. They may have no other symptoms so don't even know there is a problem until something like this happens and the diagnosis is made.
DISH generally occurs in people after age 50. It occurs more often in men than women. While the cause is unknown, there seems to be a connection with having diabetes, high blood pressure, coronary artery disease, and being overweight. Some researchers feel that the extra bone is made because of extra blood supply near the spine. Growth factors that affect the formation of calcium likely play a role.
A fall (even from ground level) or car accident can cause spinal fractures in the vertebrae already affected by this condition. Studies show there are many surgical and medical complications associated with cervical fractures in patients with DISH. These patients are at high risk for further problems during surgical management.
With a fractured skull and cervical spine fractures, there is concern for serious neurologic damage. An unstable cervical fracture can cause paralysis from spinal cord injury. Several studies reporting on conservative (nonoperative) care for serious injuries in patients like these have shown poor results. This is the main reason surgical fusion is the recommended choice of treatment for some patients.
You have probably been informed by the surgeon or medical staff that the type of problems your father may face during surgery include pneumonia, pulmonary edema (fluid in the lungs), respiratory failure, urinary tract infections, seizures, blood clots, and even death. Patients at greatest risk for complications are those who have a spinal cord injury from the cervical fracture before surgery is done.
Patients are who have this condition known as DISH and who then sustain cervical spine fractures are considered very fragile. Even with surgery serious disability is possible. Experts who have studied this problem say these patients are at high risk for poor results but the outcomes are still better than without surgery. Only the surgeon can really define the prognosis for your father. Once the surgery is complete, you'll likely have a better idea what to expect and the time frame involved.