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synonyms: diffuse idiopathic skeletal hyperostosis, ankylosing hyperostosis, vertebral osteophytosis
DISH ICD-10
- M48.10 - Ankylosing hyperostosis [Forestier], site unspecified
- M48.11 - Ankylosing hyperostosis [Forestier], occipito-atlanto-axial region
- M48.12 - Ankylosing hyperostosis [Forestier], cervical region
- M48.13 - Ankylosing hyperostosis [Forestier], cervicothoracic region
- M48.14 - Ankylosing hyperostosis [Forestier], thoracic region
- M48.15 - Ankylosing hyperostosis [Forestier], thoracolumbar region
- M48.16 - Ankylosing hyperostosis [Forestier], lumbar region
- M48.17 - Ankylosing hyperostosis [Forestier], lumbosacral region
- M48.18 - Ankylosing hyperostosis [Forestier], sacral and sacrococcygeal region
- M48.19 - Ankylosing hyperostosis [Forestier], multiple sites in spine
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
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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