Diffuse idiopathic skeletal hyperostosis (DISH) is an idiopathic disease characterized by osteophyte formation in the spine. Patience with DISH has confluent ossifications spanning 3 or more intervertebral disc spaces. This occurs most commonly in the thoracic and thoracolumbar spine. The bridging osteophytes follow the course of the anterior longitudinal ligaments and the peripheral disc margins. DISH primarily affects men more than women and occurs in those 60 years of age and older.
The predominant symptom associated with DISH is stiffness in the spine, primarily upon rising, and at the end of the day. Patients will report having symptoms that have been present, ranging from months to years. There is no radicular component associated with back pain especially originating from the thoracolumbar junction and in the lumbar region. Cervical spine involvement may present with dysphasia related symptoms as the osteophytes may press against the esophagus. Pain related to the spine is the most predominant symptom but DISH can have other joint manifestations as well. Patients will typically have limited range of motion in the thoracolumbar spine and will have difficulties with forward flexing or extending the thoracolumbar spine. This may also contribute to some loss of hip motion and knee range of motion. Radiographs of the thoracic and lumbar spine will show confluence ossifications spanning the intervertebral disc of at least 3-4 contiguous vertebral bodies. This is best seen on the lateral projection of the thoracolumbar spine. There is no loss of intervertebral disc height. There is no sacroiliac (SI) joint involvement thus differentiating DISH from Ankylosing Spondylitis. Involvement of the cervical spine will lead to ossification of the posterior longitudinal ligament and will greatly contribute to cervical myelopathy.
Mild exercise, gentle flexibility exercises and episodic use of NSAIDs are the commonly associated treatment forms for DISH. As the disease progresses other pharmacologic agents may be needed and limiting certain activities may also be necessary. In those patients who require bone surgery such as total hip or knee arthroplasty, heterotopic ossification is more likely to occur. The use of NSAIDs may help to limit this in patients who have DISH. For those patients who present with symptoms of Neurogenic claudication, pronounced myelopathy or dysphasia will require immediate examination and further diagnostic studies.
Abstract: Diffuse idiopathic skeletal hyperostosis (DISH) is an idiopathic disease characterized by osteophyte formation in the spine. Patients with DISH will have confluent ossifications spanning 3 or more intervertebral disc spaces. Stiffness and decreasing thoracolumbar ROM are predominant symptoms exhibited by patients suffering with DISH. Treatment options are primarily conservative and in rare cases need surgical correction.