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Chapters

0:00 Introduction
1:16 Causes of Diffuse Idiopathic Skeletal Hyperostosis
2:00 Symptoms of Diffuse Idiopathic Skeletal Hyperostosis
2:35 Diagnosis
3:05 Treatment



Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by abnormal calcification/bone formation (hyperostosis) of the soft tissues surrounding the joints of the spine, and also of the peripheral or appendicular skeleton.[1] In the spine, there is bone formation along the anterior longitudinal ligament and sometimes the posterior longitudinal ligament, which may lead to partial or complete fusion of adjacent vertebrae. The facet and sacroiliac joints tend to be uninvolved. The thoracic spine is the most common level involved.[2] In the peripheral skeleton, DISH manifests as a calcific enthesopathy, with pathologic bone formation at sites where ligaments and tendons attach to bone. The majority of people with DISH are not symptomatic,[3] and the findings are an incidental imaging abnormality.

In some, the xray findings may correspond to symptoms of back stiffness with flexion/extension or with mild back pain.[2] Back pain or stiffness may be worse in the morning.[4] Rarely, large anterior cervical spine osteophytes may affect the esophagus or the larynx and cause pain, difficulty swallowing[5][6] or even dyspnea.[7] Similar calcification and ossification may be seen at peripheral entheseal sites, including the shoulder, iliac crest, ischial tuberosity, trochanters of the hip, tibial tuberosities, patellae, and bones of the hands and/or feet.[6]