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Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Synonym: Forestier's Disease
A tendency for ossification of ligaments, tendons and joint capsule insertions - most characteristically affecting the spine. Calcification of the longitudinal ligaments (particularly anterior) can often produce the radiological appearance of "wax dripping from a candle", distinct from the vertebral bodies.1 The thoracic spine is mainly affected but it can also affect the lumbar and cervical spine, and other areas of the skeleton. The tendon/osseous junctions are occasionally affected around the elbow, patella, calcaneus, hip and knee joints. The cause is unknown.
The prevalence in European men over the age of 50 years is 5.8% and in women is 1.3%.2
Uncommon in patients younger than 50 years and extremely rare in patients younger than 40 years.
Is often asymptomatic and discovered by chance on x-rays or CT/MRI scans.
Symptoms include pain, stiffness, and restricted movements of the affected areas.
Thoracic vertebrae are involved in 100%, lumbar in 68-90%, and cervical in 65-78% of affected individuals.
CT and MRI scans are better at detecting associated findings (e.g. ossification of the posterior longitudinal ligament of the cervical spine) and complications (e.g. spinal cord compressive myelomalacia).3
- Compression of nerve roots may cause myelopathy.
- Overgrowth of ligamentous calcification may rarely impinge on other structures, e.g. the oesophagus.7
- Occasionally osteophytic formation in the cervical vertebrae cause cervical compression symptoms.3
- Thoracic spine osteophytes have on rare occasions been found to compress a bronchus, the larynx and trachea,8 and the inferior vena cava.9
- Reduced vertebral column flexibility predisposes to vertebral fracture.
The prognosis is usually not affected in any adverse way, unless there are complications and associated joint or soft tissue problems.
Document References
- Rochschild BM; Diffuse Idiopathic Skeletal Hyperostosis; eMedicine (2007)
- Kiss C, Szilagyi M, Mituszova M, et al;
Orv Hetil. 1997 Jun 22;138(25):1619-23. [abstract] - Cammisa M, De Serio A, Guglielmi G; Diffuse idiopathic skeletal hyperostosis. Eur J Radiol. 1998 May;27 Suppl 1:S7-11. [abstract]
- Hoffman LE, Taylor JA, Price D, et al; Diffuse idiopathic skeletal hyperostosis (DISH): a review of radiographic features and report of four cases. J Manipulative Physiol Ther. 1995 Oct;18(8):547-53. [abstract]
- Mazieres B, Rovensky J; Non-inflammatory enthesopathies of the spine: a diagnostic approach. Baillieres Best Pract Res Clin Rheumatol. 2000 Jun;14(2):201-17. [abstract]
- Kmucha ST, Cravens RB Jr; DISH syndrome and its role in dysphagia. Otolaryngol Head Neck Surg. 1994 Apr;110(4):431-6. [abstract]
- Mizuno J, Nakagawa H, Isobe M;
No Shinkei Geka. 1998 Jan;26(1):67-72. [abstract] - Papakostas K, Thakar A, Nandapalan V, et al; An unusual case of stridor due to osteophytes of the cervical spine: (Forestier's disease). J Laryngol Otol. 1999 Jan;113(1):65-7. [abstract]
- Scapinelli R; Compression of the inferior vena cava due to diffuse idiopathic skeletal hyperostosis. Rev Rhum Engl Ed. 1997 Mar;64(3):198-201. [abstract]
DocID: 2165
Document Version: 20
DocRef: bgp2443
Last Updated: 14 Apr 2007
Review Date: 13 Apr 2009
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