DISH Diffuse Idiopathic Skeletal Hyperostosis

DISH Diffuse Idiopathic Skeletal Hyperostosis

The DISH has flowing ossification along anterolateral aspect of at least four continuous vertebrae. When you look at the x-ray, you find ossification along the anterior aspect of the body but separate from the vertebrae and the disc height is preserved. It occurs in older patients (50 years and above). It affects all of the spine (more in the thoracic spine), especially on the right side, which is typical of DISH. The syndesmophytes are equal on the right and left sides in the lumbar and cervical vertebrae.

There is no involvement of the discs and there is no facet fusion or sacroiliac joint involvement. The patient may have other comorbidities such as gout or diabetes, and you need to get the hemoglobin A1c (HbA1c test) in these patients. Some patients may have high cholesterol levels. The patient will complain of back pain and spinal stiffness. DISH will have large syndesmophytes, and if the condition occurs in the neck, it will cause dysphagia, hoarseness of the voice, and sleep apnea. Diagnosis can be established by x-ray of the spine. On lateral x-ray of the cervical spine, you will find anterior bony fragments and the discs are preserved. The fractures in the spine are usually due to a hyperextension injury and can be occult, resulting from minor trauma and may have major instability. There is an increased mortality in c-spine trauma in DISH, high mortality especially in non-operative treatment. If the patient has a history of sudden neck or back pain, then the patient will be assumed to have an occult fracture, so try to get a CT scan or an MRI even if the pain is minimal and even if the x-rays appear normal. Heterotopic ossification after total hip arthroplasty is more in patients with DISH.

What is the difference between DISH and Ankylosing Spondylitis?

DISH

-Flowing large syndesmophytes

-No bamboo spine

-Sacroiliac (SI) join will not be involved

-Occurs in older patients

-some patients may have diabetes, check hemoglobin A1c

Ankylosing Spondylitis

-Diffuse ossification of the disc space without large osteophytes

-Bamboo spine

-The patient is usually young

-Sacroiliac (SI) joint is involved

-HLA-B27 is positive in about 90% of the time

-Limited chest expansion