Diffuse Idiopathic Skeletal Hyperostosis Ossification of the longitudinal ligaments
Diffuse Idiopathic Skeletal Hyperostosis
What is DISH?
Diffuse Idiopathic Skeletal Hyperostosis is a phenomenon discovered inadvertently characterized by a
tendency toward ossification of ligaments. Most commonly affected is the spinal region. Ossification
of the longitudinal ligaments of the spine produces a tortuous paravertebral mass anterior to and
distinct from the vertebral bodies. The zygapophyseal and sacroiliac joints are not involved in DISH,
and the intervening intervertebral disk space is not affected.
What does that mean?
Diffuse means widespread, idiopathic means for unknown reasons, and skeletal hyperostosis means bony growth of the skeleton.
This why rheumatologists are not able to provide an explanation as to what causes DISH.
What causes DISH?
There is no known cause of DISH. It is an idiopathic phenomenon that is often misdiagnosed in the
early stages. Diagnostic tests include x-rays, magnetic resonance imaging (MRI), computed tomography
scan (CT or CAT scan), and bone heat imaging. DISH occurs more commonly in males (65%) than in females (35%).
In the US, DISH is found in approximately 28% of men older than 80 years. DISH is present in approximately
19% of men older than 50, but in only 4% of women over 50. DISH is uncommon in patients younger than 50, and
extremely rare in patients younger than 40 years of age.
What are the symptoms?
Typically the bony spurs that develop as a result of diffuse idiopathic skeletal hyperostosis do not cause symptoms,
rather they are a reflection of bone response to local inflammation. The inflammation generally occurs at sites
where soft tissues, such as ligaments around the discs and tendons, attach to bone.
Symptoms of DISH include intermittent pains in the areas where the changes occur to bones of the spine and inflamed tendons,
or from a secondary muscle spasm in the same area. Stiffness and dull pain, particularly in the upper and lower back, are
common. Sometimes pains in these areas can be sharp with certain body movements, such as twisting or bending over.
Treatment for DISH
There are only a couple treatments being used for DISH at this time. Walking and exercise programs including water exercise are
the most common initial treatments. Non-steriodal anti-inflammatory drugs (NSAID's) can help, but for most patients with DISH pain
is usually mild and tolerable. The most common NSAID's recommended for this condition are medications such as Advil,
ibuprofen, Motrin, Medipren, Nuprin, Lodine, Naproxen(Aleve), indomethacin(Indocin), and nabumetone(Relafen).
Some of these medications are available Over The Counter(OTC), and some are by prescription only. Occasionally, local cortisone
injections and ice applications can be helpful for inflamed tendons and plantar areas. Surgery is rarely performed for DISH. When
large bony spurs in front of the spine in the neck impede normal swallowing (not common, but does occur), surgical removal of
the spur is sometimes performed.
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