Delayed diagnosis of a cervical DISH fracture leading to dropped head deformity treated with combined anterior–posterior stabilisation

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disorder that causes spinal ankylosis, predisposing patients to unstable fractures even after minor trauma. Because such fractures may occur without neurological deficits and can be obscured by extensive ossification, diagnosis is often delayed. We describe a male in his late sixties with DISH who developed progressive dropped-head deformity after an unrecognised cervical fracture sustained in a ground-level fall. Ten months later, imaging revealed a chronic C5–6 pseudoarthrosis with severe kyphosis. Gradual halo traction was followed by a combined anterior C5–six fusion and posterior C2–T2 fixation, achieving circumferential stability. Neck pain and deformity resolved completely and solid fusion was confirmed at a 2-year follow-up. This case illustrates that even low-energy trauma can cause occult, unstable fractures in ankylosed spines. Early CT evaluation and timely circumferential stabilisation are essential to prevent pseudoarthrosis, deformity and neurological deterioration in patients with DISH.