Global Spine Journal - 2026-04-18 - Journal Article
Impact of Ankylosing Spondylitis/Diffuse Idiopathic Skeletal Hyperostosis on Postoperative and Patient-Reported Outcomes Following Elective Cervical and Lumbar Surgery.
Fano A, Baidya J, Baek G, Ng M, Giakas A, Dalton J, Narayanan R, Huang R, Herczeg C, Oris RJ, Olson J, Eichbaum Y, Green W, Mathew J, Carter M, Pohl N, Sabitsky M, Fras S, Cronk R, Rihn JA, Kaye ID, Cha T, Canseco J, Hilibrand A, Vaccaro A, Kepler C, Schroeder G
Topics
Key Takeaway
AS/DISH patients undergoing elective spinal fusion had 6× higher odds of 30-day readmission (OR 6.04, 95% CI 1.84–23.38) despite achieving superior or equivalent functional PROMs compared to matched controls.
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Summary
This study compared perioperative and PROM outcomes between AS/DISH patients and propensity-matched controls undergoing elective ACDF, PCDF, PLDF, or TLIF. AS/DISH patients had significantly higher 30-day readmission rates for both cervical (9.5% vs 1.6%) and lumbar (20.8% vs 2.8%) procedures, with AS/DISH independently predicting readmission on multivariable regression (OR 6.04). Despite this, cervical AS/DISH patients showed superior VAS Neck, VAS Arm, and mJOA scores at multiple postoperative timepoints, and lumbar AS/DISH patients had greater early axial pain improvement though smaller radicular leg pain gains.
Key Limitation
The AS/DISH cohort is small (n=66, with only 24 lumbar cases), limiting the ability to distinguish AS from DISH as separate disease entities with potentially different risk profiles and outcome trajectories.
Original Abstract
Study DesignRetrospective cohort.ObjectiveLimited evidence exists for outcomes after elective cervical and lumbar fusion in patients with ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). This study aimed to compare perioperative and patient-reported outcomes between patients with AS/DISH and matched control patients.MethodsAdults with AS/DISH undergoing primary elective ACDF, PCDF, PLDF, or TLIF from 2004-2023 were identified. AS/DISH patients were propensity score matched (1:3) to controls without ankylosing disorders. Outcomes included readmission rates, discharge disposition, revision/reoperation, and patient-reported outcome measures at baseline and follow-up. Chi-square and t-tests were used, with P < 0.05 as significant.Results66 AS/DISH patients (42 cervical, 24 lumbar) were matched to 198 controls. AS/DISH patients had higher Charlson Comorbidity Index scores and greater 0-30 day readmission rates for both cervical (9.5% vs 1.6%, P = 0.035) and lumbar (20.8% vs 2.8%, P = 0.010) fusions. Cervical AS/DISH patients demonstrated superior VAS Neck, VAS Arm, and mJOA scores at several postoperative timepoints. Lumbar AS/DISH patients showed greater early VAS Back improvement (Δ6-month -4.00 vs -2.91, P = 0.010) but smaller VAS Leg gains (Δ6-month -1.50 vs -4.13, P = 0.021). Multivariable regression controlling for CCI score, male sex, and AS/DISH diagnosis identified that a diagnosis of AS/DISH was independently associated with greater odds of 30-day readmissions (OR: 6.04, 95% CI: 1.84-23.38, P = 0.004).ConclusionAS/DISH is associated with increased short-term readmissions after elective spinal fusion, despite some superior functional outcomes in cervical procedures. Future studies should evaluate whether targeted perioperative optimization can reduce these risks.