DISH

synonyms: diffuse idiopathic skeletal hyperostosis, ankylosing hyperostosis, vertebral osteophytosis

DISH ICD-9

• 721.6 Ankylosing vertebral hyperostosis

DISH Etiology / Epidemiology / Natural History

• DISH = confluent ossification of at least four continuous vetrebral bodies (3 disc spaces)
• General white males < 60 years old.

DISH Anatomy

• Bridging ossification follows the course of the anterior longitudinal ligament

DISH Clinical Evaluation

• Main complaint is generally stiffness which may be worse in the morning and evening.
• Mild lumbar and thoracolumbar back pain
• Decreased spinal ROM.

DISH Xray / Diagnositc Tests

• A/P and lateral views of the thoracic and lumbar spine demonstrate confluent ossification of at least four continguous vertebral bodies.
• Cervical spine involvement

DISH Classification / Treatment

• Aerobic activity / exercise. Activity modifications, NSAIDs.
• Cervical spine involvement may lead to dysphasia from large osteophytes or myelopathy from ossication of the posterior longitudinal ligament.

DISH Associated Injuries / Differential Diagnosis

• Cervical myelopathy
• Acromegaly
• Ankylosing spondylitis
• Degenerative disc disease
• Paget disease
• Polymyalgia rheumatica

DISH Complications

• Myelopathy
• Neurogenic claudication
• Dysphagia
• Heterotopic ossification (after THA)

DISH Follow-up Care

DISH Review References

• Belanger TA, JAAOS 2001;9:258

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