The distinctive radiological feature of DISH is the continuous linear calcification along the antero-medial aspect of the thoracic spine. DISH is usually found in people in their 60s and above, and is extremely rare in people in their 30s and 40s.
What does dish stand for in medical terms?
Diffuse idiopathic skeletal hyperostosis (DISH) Print. Diffuse idiopathic skeletal hyperostosis (DISH) is a bony hardening of ligaments in areas where they attach to your spine. Also known as Forestier's disease, this condition might not cause symptoms or require treatment.
What is dish disease of the spine?
Diffuse idiopathic skeletal hyperostosis (DISH) is a bony hardening of ligaments in areas where they attach to your spine. Also known as Forestier's disease, this condition might not cause symptoms or require treatment.
When is CT or MRI indicated in the evaluation of dish?
CT and MRI are useful in the evaluation of trauma and in the rare cases of spinal stenosis in patients with DISH that are caused by ossification of spinal ligaments or hypertrophy of the apophyseal joints [ 2 ]. Fig. 1A —52-year-old man with diffuse idiopathic skeletal hyperostosis.
What is the imaging finding in dish?
This atlas is intended to show the imaging finding in DISH in patients diagnosed with the condition by the Resnick classification criteria. 1 In the initial stages of the disease, small bony areas in front of the disk space can be observed in the sagittal projection.
What does DISH mean on xray?
Diffuse idiopathic skeletal hyperostosis (DISH) is a bony hardening of ligaments in areas where they attach to your spine. Also known as Forestier's disease, this condition might not cause symptoms or require treatment.
Does DISH show up on a MRI?
Spinal MRI lesions that are characteristic of axial SpA were commonly observed in a cohort of patients with DISH. This bears relevance to cases with diagnostic uncertainty and may imply overlapping pathogenetic mechanisms for new bone formation in both SpA and DISH.
What are the symptoms of DISH?
When symptoms of DISH do occur, they include:Numbness or tingling in legs.Pain.Reduced mobility.Stiffness.Trouble swallowing or hoarseness (abnormal voice changes) if DISH develops in the neck.
Is DISH a degenerative disc disease?
Resnick et al. [2] defined DISH as the presence of four or more vertebral bodies with continuous ossification of the anterior spinal ligaments and the absence of degenerative disc disease.
How is DISH diagnosed?
Doctors generally diagnose DISH based on a thorough physical exam and imaging tests, such as x-rays, CT scans or MRIs. The same tests may also be done to rule out other problems with similar symptoms.
Is DISH a disability?
DISH is clearly a distinct disorder with signs and symptoms that distinguish it from other causes of spinal complaint and from healthy individuals. It has the potential to cause major disability. Future studies need to address the natural history of DISH, pursue pathogenic mechanisms, and evaluate treatment modalities.
How can you tell the difference between ankylosing spondylitis and DISH?
DISH affects predominantly middle-aged and elderly people, and has a strong association with diabetes mellitus and obesity. Ankylosing spondylitis (AS), on the other hand, is an inflammatory disorder of the axial skeleton that typically develops in early adulthood.
How common is DISH?
It becomes more common with age. One study estimated that it may be present in as many as 25 percent of men and 15 percent of women over age 50 in the United States. Since many people have no symptoms, DISH is often diagnosed only when imaging studies are done for some other reason.
How is DISH disease treated?
Your doctor might recommend over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others). More-severe pain can be treated with corticosteroid injections.
Can you adjust a patient with DISH?
Once bone spurs are identified and DISH is diagnosed, a treatment plan must be created to help the patient manage their symptoms. Chiropractic treatment may be useful in improving the patient's range of motion in the spine and decreasing pain or stiffness.
Can DISH cause breathing problems?
The present cases indicate that restrictive ventilatory function caused by thoracic lesions may lead to severe respiratory failure in patients with DISH.
Does DISH cause back pain?
DISH may or may not cause symptoms. If DISH causes symptoms, these may include: Stiffness (most noticeable in the morning or in the evening) Pain in the back, especially in the upper back.
Is DISH an inflammatory disease?
Diffuse idiopathic skeletal hyperostosis (DISH) is a disease of the back or spine. Unlike other types of arthritis, it does not involve inflammation.
Is DISH related to ankylosing spondylitis?
DISH and ankylosing spondylitis (AS) are both forms of arthritis that can result in significant back pain and loss of mobility. However, they have different causes and mechanisms. AS is a result of chronic inflammation of the joints, whereas DISH is a result of ligament calcification and ossification.
Does DISH cause rib pain?
DISH occurs most commonly in the thoracolumbar spine, but it also can affect the cervical spine, ribs, and bones of the pelvis. DISH causes stiffness and pain of the cervical and thoracolumbar spine. The symptoms are worse on wakening and at night.
Diffuse Idiopathic Skeletal Hyperostosis (DISH) Treatment, Symptoms
Diffuse idiopathic skeletal hyperostosis (DISH) - Mayo Clinic
DISH | Back pain | Symptoms, treatments | Versus Arthritis
Diffuse idiopathic skeletal hyperostosis - Radiopaedia.org
3 case question available
A: Ankylosing spondylitis is a very close differential diagnosis, however, the following points favor the diagnosis of DISH: old age; bulky syndesmophytes; sparing the synovial portion of sacroiliac joint; calcification of the bridging sacroiliac ligament.
Case Discussion
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition where there is flowing ossification of the anterior longitudinal ligament involving the thoracic spine and enthesopathy (e.g. at the iliac crest, ischial tuberosities, and greater trochanters). There is no involvement of the sacroiliac synovial joint.
Signs and symptoms
The majority of people with DISH are not symptomatic, and the findings are an incidental imaging abnormality .
Cause
The exact cause is unknown. Mechanical, dietary factors and use of some medications (e.g. isotretinoin, etretinate, acitretin and other vitamin A derivatives) may be of significance. There is a correlation between these factors but not a cause or effect.
Diagnosis
DISH is diagnosed by findings on x-ray studies. Radiographs of the spine will show abnormal bone formation (ossification) along the anterior spinal ligament. The disc spaces, facet and sacroiliac joints remain unaffected. Diagnosis requires confluent ossification of at least four contiguous vertebral bodies.
Treatment
There is limited scientific evidence for the treatment for symptomatic DISH.
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterised by calcification and ossification of ligaments and entheses. The condition usually affects the axial skeleton, in particular, at the thoracic segment, though also other portions of the spine are often involved.
Introduction
Diffuse idiopathic skeletal hyperostosis (DISH), is a condition characterised by calcification and ossification of ligaments and entheses. The condition usually affects the axial skeleton, in particular at the thoracic segment though also other portions of the spine are often involved.
Thoracic spine
In the initial stages of the disease, small bony areas in front of the disk space can be observed in the sagittal projection. Then, laminar ossifications appear in the medial–inferior and medial–superior portion of the anterior and lateral vertebral margins.
Lumbar spine
The upper lumbar segments are involved in a large percentage of cases. Radiographical abnormalities along the anterior aspect of the lumbar spine are similar to those of the cervical spine. Unlike the thoracic spine, the flowing ossifications are equally frequent on the right and left sides of the lumbar spine.
Cervical spine
The hyperostotic process develops along the lower half of the anterior border of the vertebral body: morphological aspects are described appears as ‘falling drop’ or as prevertebral drop at the front of the vertebrae.
Peripheral involvement
Peripheral involvement in DISH is characterised by several distinctive features:
DISH and ankylosing spondylitis (AS)
DISH and AS are the prototypes of hyperostotic diseases of the axial skeleton. 6 The bone proliferation leads in the long term to ankylosis of the spine and functional impairment.
Overview
Diffuse idiopathic skeletal hyperostosis (DISH) is a bony hardening of ligaments in areas where they attach to your spine.
Symptoms
You might have no signs or symptoms with DISH. For those who have signs and symptoms, the upper portion of the back is most commonly affected. Signs and symptoms might include:
Causes
DISH is caused by the buildup of calcium salts in the ligaments and tendons and a hardening and overgrowth of bone. But what causes these to occur is unknown.
Risk factors
Doctors have some idea of what can increase your risk of the condition. Risk factors include:
Epidemiology
- DISH most commonly affects the elderly, especially 6th to 7th decades 3. The estimated frequency in the elderly is ~10% 6, with a male predominance. Recognized associations include: 1. ossification of the posterior longitudinal ligament, which may be a cause of spinal stenosis 2. hy…
Clinical Presentation
- The condition is commonly identified as an incidental finding when imaging for other reasons. However, spine stiffness and decreased mobility are referred to as possible symptoms.
Radiographic Features
- flowing ossifications: florid, flowing ossification along the anterior or right 7anterolateral aspects of at least four contiguous vertebrae
- disc spaces are usually well preserved
- ankylosis is more common in the thoracic than cervical or lumbar spine
- no sacroiliitis or facet joint ankylosis although sacroiliac joint anterior bridging, posterior brid…
- flowing ossifications: florid, flowing ossification along the anterior or right 7anterolateral aspects of at least four contiguous vertebrae
- disc spaces are usually well preserved
- ankylosis is more common in the thoracic than cervical or lumbar spine
- no sacroiliitis or facet joint ankylosis although sacroiliac joint anterior bridging, posterior bridging, entheseal bridging may be present 10
Treatment and Prognosis
- DISH is generally managed clinically with analgesics and non-steroidal anti-inflammatory drugs when pain and stiffness are related. Possible complications may require specific treatment: 1. acute spinal fractures 1.1. chalk stick fracture 2. rarely dysphagia caused by mechanical compression due to anterior cervical bone production 8
Differential Diagnosis
Overview
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. In the spine, there is bone formation along the anterior longitudinal ligament and sometimes the posterior longitudinal ligament, which may lead t…
Signs and symptoms
The majority of people with DISH are not symptomatic, and the findings are an incidental imaging abnormality.
In some, the x-ray findings may correspond to symptoms of back stiffness with flexion/extension or with mild back pain. Back pain or stiffness may be worse in the morning. Rarely, large anterior cervical spine osteophytes may affect the esophagus or the larynx and cause pain, difficulty swall…
Cause
The exact cause is unknown. Mechanical, dietary factors and use of some medications (e.g. isotretinoin, etretinate, acitretin and other vitamin A derivatives) may be of significance. There is a correlation between these factors but not a cause or effect. The distinctive radiological feature of DISH is the continuous linear calcification along the antero-medial aspect of the thoracic spine. DISH is usually found in people in their 60s and above, and is extremely rare in people in their 30…
Diagnosis
DISH is diagnosed by findings on x-ray studies. Radiographs of the spine will show abnormal bone formation (ossification) along the anterior spinal ligament. The disc spaces, facet and sacroiliac joints remain unaffected. Diagnosis requires confluent ossification of at least four contiguous vertebral bodies. Classically, advanced disease may have "melted candle wax" appearance alon…
Treatment
There is limited scientific evidence for the treatment for symptomatic DISH.
Symptoms of pain and stiffness may be treated with conservative measures, analgesic medications (such as non-steroidal anti-inflammatory drugs), and physical therapy.
In extraordinary cases where calcification or osteophyte formation is causing severe and focal symptoms, such as difficulty swallowing or nerve impingement, surgical intervention may be pur…
See also
• Ankylosing spondylitis
• Enthesitis
• Osteoarthritis
• Retinoids