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Neurological Rehabilitation

Rigidity Meets Instability: Delayed Cervical Osteophyte-Induced Spinal Cord Injury in a Patient with Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater

    Poster Presenter(s)

  • S Raza Husain, DO

    Resident Physician
    Rutgers New Jersey Medical School PM&R Program
    West Orange, New Jersey

    • Co-Author(s)

  • Anthony Lee, MD

    Director of Amputee Services
    Kessler Institute for Rehabilitation - Saddle Brook
    Saddle Brook, New Jersey

Disclosure(s):
Anthony Lee, MD: No financial relationships to disclose
Case Diagnosis: Tetraplegia due to delayed cervical osteophyte-induced spinal cord injury in a patient with Diffuse Idiopathic Skeletal Hyperostosis (DISH) following a low-energy fall

Case Description or Program Description: A 65-year-old male presented to the emergency department after a mechanical fall from low ladder height, striking his shoulder and head without loss of consciousness. Imaging showed anterior longitudinal ligament ossification (C2-C6) with bridging osteophytes, and preserved intervertebral disc height, consistent with DISH. Despite this, due to a reassuring neurological exam, he was discharged with a hard cervical collar and follow-up.

After returning home, he noted difficulty with stand-to-sit due to shoulder pain. While attempting to sit onto the toilet an uncontrolled drop triggered sudden cervical pain and quadriparesis. Repeat imaging demonstrated a fracture of the C5-6 osteophyte, resulting in cervical cord compression with myelopathy. He underwent emergent spinal stabilization with a C4-C6 anterior cervical discectomy and fusion (ACDF). Symptoms began improving shortly thereafter, with spontaneous movement in all extremities.

Setting: Inpatient rehabilitation service

Assessment/Results: He was admitted to acute rehabilitation with a C5 AIS D spinal cord injury, dysphagia, and urinary retention. He required moderate assistance for ADLs due to impaired dexterity and maximal assistance for ambulation with a rolling walker. At discharge, he was independent in ADLs and close supervision ambulation without an aid.

Discussion (relevance): Ossification of the ALL and bridging osteophytes in DISH can create a rigid yet mechanically unstable spine, making it susceptible to fractures even after seemingly minor trauma. This case underscores how patients with DISH may initially appear neurologically intact after a fall, yet delayed spinal cord compression can occur due to occult mechanical instability.

Conclusions: DISH predisposes patients to central cord syndrome following hyperextension trauma due to a combination of osteophyte-induced spinal stenosis and rigid spine mechanics. Although SCI in ankylosing hyperostotic conditions can be severe, early recognition, decompression, and interdisciplinary rehabilitation can optimize outcomes.