Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Diffuse Idiopathic Skeletal Hyperostosis (DISH) Follow-up

  • Author: Bruce M Rothschild, MD; Chief Editor: Jeffrey D Thomson, MD  more...
 
Updated: Jul 11, 2016
 

Complications

Overgrowth of ligamentous calcification could impinge on other structures (eg, the esophagus). Reports of this are rare and often represent inadvertently discovered, neurologically mediated swallowing deficits.[30, 31]

Posterior longitudinal ligament ossifications may impinge on the spinal cord on rare occasions.

Reduced vertebral column flexibility predisposes to vertebral fracture. Vertebral fracture risk (cervical, 60%; thoracic, 34.5%; lumbar, 5.5%) is inherent with an ankylosed hyperostotic vertebral column from minor trauma, preoperative and postoperative positioning, or intraoperative maneuvers (eg, retroperitoneal or hip replacement surgery).[3, 32, 33] Note that as well as with fully ankylosed spines, partially ankylosed spines also are at risk, with fractures occurring adjacent to the fused regions.[34] The risk of fracture increases with the number of vertebra ankylosed.[35] Obesity is an additional risk factor for fracture,[36] overstressing the already at-risk spine.

Next

Prognosis

The prognosis is excellent, as diffuse idiopathic skeletal hyperostosis (DISH) is not a source of morbidity or mortality.

Previous
 
Contributor Information and Disclosures
Author

Bruce M Rothschild, MD Professor of Medicine, Northeast Ohio Medical University; Adjunct Professor, Department of Biomedical Engineering, University of Akron; Research Associate, University of Kansas Museum of Natural History; Research Associate, Carnegie Museum

Bruce M Rothschild, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Rheumatology, International Skeletal Society, New York Academy of Sciences, Sigma Xi, Society of Skeletal Radiology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

George H Thompson, MD Director of Pediatric Orthopedic Surgery, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, and MetroHealth Medical Center; Professor of Orthopedic Surgery and Pediatrics, Case Western Reserve University School of Medicine

George H Thompson, MD is a member of the following medical societies: American Orthopaedic Association, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, American Academy of Orthopaedic Surgeons

Disclosure: Received none from OrthoPediatrics for consulting; Received salary from Journal of Pediatric Orthopaedics for management position; Received none from SpineForm for consulting; Received none from SICOT for board membership.

Chief Editor

Jeffrey D Thomson, MD Associate Professor, Department of Orthopedic Surgery, University of Connecticut School of Medicine; Director of Orthopedic Surgery, Department of Pediatric Orthopedic Surgery, Associate Director of Clinical Affairs for the Department of Surgical Subspecialties, Connecticut Children’s Medical Center; President, Connecticut Children's Specialty Group

Jeffrey D Thomson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Mininder S Kocher, MD, MPH Associate Professor of Orthopedic Surgery, Harvard Medical School/Harvard School of Public Health; Associate Director, Division of Sports Medicine, Department of Orthopedic Surgery, Children's Hospital Boston

Mininder S Kocher, MD, MPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Sports Medicine, Pediatric Orthopaedic Society of North America, American Association for the History of Medicine, American Orthopaedic Society for Sports Medicine, Massachusetts Medical Society

Disclosure: Received consulting fee from Smith & Nephew Endoscopy for consulting; Received consulting fee from EBI Biomet for consulting; Received consulting fee from OrthoPediatrics for consulting; Received stock from Pivot Medical for consulting; Received consulting fee from pediped for consulting; Received royalty from WB Saunders for none; Received stock from Fixes-4-Kids for consulting.

References
  1. Holgate RL, Steyn M. Diffuse idiopathic skeletal hyperostosis: Diagnostic, clinical, and paleopathological considerations. Clin Anat. 2016 Mar 23. [Medline].

  2. Nascimento FA, Gatto LA, Lages RO, Neto HM, Demartini Z, Koppe GL. Diffuse idiopathic skeletal hyperostosis: A review. Surg Neurol Int. 2014. 5 (Suppl 3):S122-5. [Medline]. [Full Text].

  3. Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009 Feb. 18(2):145-56. [Medline]. [Full Text].

  4. Rothschild BM, Woods R. Old World spondylarthropathy: the gorilla connection. Arthritis Rheum. 1988 Jul. 31(7):934-5. [Medline].

  5. Ferigolo J. Estudos multidisciplinares. Goncalves de Araujo AJ, Ferreira LF, eds. Non-human Vertebrate Paleopathology. Brazil: Panorama; 1988. 213-34.

  6. Bjorkengren AG, Sartoris DJ, Shermis S, et al. Patterns of paravertebral ossification in the prehistoric saber-toothed cat. AJR Am J Roentgenol. 1987 Apr. 148(4):779-82. [Medline].

  7. McDonald JN, Bartlett CS Jr. An associated musk ox skeleton from Saltville, Virginia. J Vert Paleontol. 1983. 2:453-470.

  8. Moodie RL. Studies in Paleopathology: XX. Vertebral lesions in the sabre-tooth, Pleistocene of California, resembling the so-called Myositis Ossificans Progressiva, compared with certain ossifications in the dinosaurs. Ann Med Hist. 1927. 9:91-102.

  9. Rothschild BM. Scientifically rigorous reptile and amphibian osseous pathology: Lessons for forensic herpetology from comparative and paleo-pathology. Applied Herpetology. 2008. 10:39-116.

  10. Rothschild BM. Skeletal paleopathology of rheumatic diseases: the subprimate connection. McCarty DJ, ed. Arthritis and Allied Conditions. 11th ed. Philadelphia, Pa: Lea and Febiger; 1989. 3-7.

  11. Rothschild BM. Diffuse idiopathic skeletal hyperostosis as reflected in the paleontologic record: dinosaurs and early mammals. Semin Arthritis Rheum. 1987 Nov. 17(2):119-25. [Medline].

  12. Rothschild BM, Berman D. Fusion of caudal vertebrae in late Jurassic sauropods. J Vert Paleontol. 1991. 11(1):29-36.

  13. Rothschild BM, Martin LD. Paleopathology: Disease in the Fossil Record. Boca Raton, Fla: CRC Press;. 1993.

  14. Fornasier VL, Littlejohn G, Urowitz MB, et al. Spinal entheseal new bone formation: the early changes of spinal diffuse idiopathic skeletal hyperostosis. J Rheumatol. 1983 Dec. 10(6):939-47. [Medline].

  15. Rothschild BM. Diffuse idiopathic skeletal hyperostosis (DISH): misconceptions and reality. Clin Rheumatol. 1985. 4:207-12.

  16. Ono M, Russell WJ, Kudo S, et al. Ossification of the thoracic posterior longitudinal ligament in a fixed population. Radiological and neurological manifestations. Radiology. 1982 May. 143(2):469-74. [Medline].

  17. Tsuyama N. Ossification of the posterior longitudinal ligament of the spine. Clin Orthop Relat Res. 1984 Apr. 71-84. [Medline].

  18. Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC. The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in the Netherlands. J Rheumatol. 2008 Aug. 35(8):1635-8. [Medline].

  19. Schlapbach P, Beyeler C, Gerber NJ, et al. Diffuse idiopathic skeletal hyperostosis (DISH) of the spine: a cause of back pain? A controlled study. Br J Rheumatol. 1989 Aug. 28(4):299-303. [Medline].

  20. Holton KF, Denard PJ, Yoo JU, Kado DM, Barrett-Connor E, Marshall LM. Diffuse Idiopathic Skeletal Hyperostosis and Its Relation to Back Pain Among Older Men: The MrOS Study. Semin Arthritis Rheum. 2011 Mar 3. [Medline].

  21. Julkunen H, Knekt P, Aromaa A. Spondylosis deformans and diffuse idiopathic skeletal hyperostosis (DISH) in Finland. Scand J Rheumatol. 1981. 10(3):193-203. [Medline].

  22. Olivieri I, D'Angelo S, Cutro MS, Padula A, Peruz G, Montaruli M, et al. Diffuse idiopathic skeletal hyperostosis may give the typical postural abnormalities of advanced ankylosing spondylitis. Rheumatology (Oxford). 2007 Nov. 46(11):1709-11. [Medline].

  23. Mader R, Novofestovski I, Adawi M, Lavi I. Metabolic Syndrome and Cardiovascular Risk in Patients with Diffuse Idiopathic Skeletal Hyperostosis. Semin Arthritis Rheum. 2008 Feb 25. [Medline].

  24. Daragon A, Mejjad O, Czernichow P, et al. Vertebral hyperostosis and diabetes mellitus: a case-control study. Ann Rheum Dis. 1995 May. 54(5):375-8. [Medline].

  25. Resnick D, Niwayama G. Diagnosis of Bone and Joint Disorders. 2nd ed. Philadelphia PA: WB Saunders; 1563-615.

  26. Yunoki M, Suzuki K, Uneda A, Okubo S, Hirashita K, Yoshino K. The Importance of Recognizing Diffuse Idiopathic Skeletal Hyperostosis for Neurosurgeons: A Review. Neurol Med Chir (Tokyo). 2016 Mar 28. [Medline]. [Full Text].

  27. Slonimsky E, Leibushor N, Aharoni D, Lidar M, Eshed I. Pelvic enthesopathy on CT is significantly more prevalent in patients with diffuse idiopathic skeletal hyperostosis (DISH) compared with matched control patients. Clin Rheumatol. 2016 Jul. 35 (7):1823-7. [Medline].

  28. Kuperus JS, Westerveld LA, Rutges JA, Alblas J, van Rijen MH, Bleys RL, et al. Histological characteristics of diffuse idiopathic skeletal hyperostosis. J Orthop Res. 2016 Apr 21. [Medline].

  29. Seawright AA, English PB, Gartner RJ. Hypervitaminosis A and hyperostosis of the cat. Nature. 1965 Jun 12. 206(989):1171-2. [Medline].

  30. Seidler TO, Pèrez Àlvarez JC, Wonneberger K, Hacki T. Dysphagia caused by ventral osteophytes of the cervical spine: clinical and radiographic findings. Eur Arch Otorhinolaryngol. 2008 Jun 28. [Medline].

  31. Burduk PK, Wierzchowska M, Grzelalak L, Dalke K, Mierzwinski J. Diffuse idiopathic skeletal hyperostosis inducted stridor and dysphagia. Otolaryngol Pol. 2008. 62(2):138-40. [Medline].

  32. Israel Z, Mosheiff R, Gross E, Muggia-Sullam M, Floman Y. Hyperextension fracture-dislocation of the thoracic spine with paraplegia in a patient with diffuse idiopathic skeletal hyperostosis. J Spinal Disord. 1994 Oct. 7(5):455-7. [Medline].

  33. Königshausen M, Dudda M, Merle C, Schildhauer TA, Fehmer T. Thoracic vertebral body fracture after total hip replacement in diffuse idiopathic skeletal hyperostosis. Orthopedics. 2012 Jun. 35(6):e1000-4. [Medline].

  34. Paley D, Schwartz M, Cooper P, Harris WR, Levine AM. Fractures of the spine in diffuse idiopathic skeletal hyperostosis. Clin Orthop Relat Res. 1991 Jun. 22-32. [Medline].

  35. Hendrix RW, Melany M, Miller F, Rogers LF. Fracture of the spine in patients with ankylosis due to diffuse skeletal hyperostosis: clinical and imaging findings. AJR Am J Roentgenol. 1994 Apr. 162(4):899-904. [Medline].

  36. Matejka J. [Hyperextension injuries of the thoracolumbar spine]. Zentralbl Chir. 2006 Feb. 131(1):75-9. [Medline].

  37. Fish DE, Middleton K, Gluzman A. Atypical Presentation of Osteomyelitis, Discitis, Epidural, and Iliopsoas Abscess in DISH Syndrome. Am J Phys Med Rehabil. 2008 Aug 6. [Medline].

  38. Ozkalkanli MY, Katircioglu K, Ozkalkanli DT, et al. Airway management of a patient with Forestier's disease. J Anesth. 2006. 20(4):304-6. [Medline].

  39. Mader R. Diffuse idiopathic skeletal hyperostosis: time for a change. J Rheumatol. 2008 Mar. 35 (3):377-9. [Medline]. [Full Text].

 
Previous
Next
 
Radiograph of the thoracic spine (anteroposterior view) showing osteophytes on the right side only, a feature typical of diffuse idiopathic skeletal hyperostosis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.