- General
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Also known as Forestier disease,
- Numbers
- DISH has an overall incidence of 6– 12%
- more common in patients over the age of 50 years.
- Definition
- Presence of non- marginal syndesmophytes at three successive levels (involving four contiguous vertebrae) and appears radiologically as flowing anterior ossification of the anterior longitudinal ligament with disc space preservation.
- Vs ankylosing spondylitis
- DISH has an absence of facet joint ankylosis, sacroiliac joint erosion, sclerosis, or intra-articular osseous fusion, and there is usually no osteopaenia.
DISH | Ankylosing spondylitis | |
Syndesmophytes | Nonmarginal | Marginal |
Radiographs | "Flowing candle wax" | "Bamboo spine", squaring of vertebral bodies, "shiny corners" at attachment of annulus fibrosus (Romanus lesions) |
Disc space | Preservation of disc space | AS in cervical spine will show ossification of disc space |
Osteopenia | No osteopenia (rather, there may be increased radiodensity) | Osteopenia present |
HLA | No evidence of association with HLA-B27. Associated with HLA-B8 (common in patients with DISH and diabetes) | Strong association with HLA-B27 |
Age group | Older patients (middle aged) | Younger patients |
SI joint involvement | No involvement (SI joint abnormality generally excludes diagnosis of DISH) | Bilateral sacroiliitis |
Diabetes | Yes | No |
- Symptoms
- Stiffness and pain.
- High risk of fracture with minor injury
- With large anterior syndesmophytes, dysphagia, stridor, and hoarseness of voice may also, rarely, be surgical indications.
- Clinical features
- Associated degenerative changes in the disc with osteophytes can lead to myeloradiculopathy.
- Tx
- Most cases are treated if canal stenosis results in symptomatic myeloradiculopathy.
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