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diffuse idiopathic skeletal hyperostosis (DISH, Forestier disease, ankylosing hyperostosis of the spine, spondylosis hyperostotica)

Variant of primary osteoarthritis. Etiology: - idiopathic Epidemiology: 1) occurs primarily in men > 50 years of age 2) up to 10% of elderly persons Pathology: - non-inflammatory flowing ossification along anterolateral aspect of vertebral bodies (>= 4) - may occur with or without osteoarthritis of the spine or inflammatory arthritis [2] - represents a separate finding of ectopic calcification of spinal ligaments & entheses [2] Clinical manifestations: 1) generally asymptomatic or minimally symptomatic 2) patients are frequently obese 3) diabetes or glucose intolerance (60%) 4) mild back stiffness - reduced range of motion, esp. at the thoracic spine [2] 5) occasional back pain Radiology: - radiograph of spine - no vertically bridging syndesmophytes - osteophytes connecting 4 or more vertebrae - along anterolateral aspect - most easily seen in the thoracic spine [2] - preservation of disk space [1,2]; narrowing of disk space [2] - preservation of vertebral height [2] - usually on right side of spine [2] - calcification of anterior longitudinal ligaments [2] - encroachment of intervertebral foramina by osteophytes - bridging horizontal syndesphophytes [2] - calcification of pelvic & spinal ligaments - radiograph of saroiliac joint - absence of sacroiliac joint inflammatory changes (erosions) - radiographs - calcification of enthesis (where tendons & ligaments insert into bone) - osteophytes at sites of osteoarthritis - acetabular, olecranon, calcaneus & patellar spurs - hypertrophic bone formation after joint arthroplasty Differential diagnosis: - ankylosing spondylitis (vertically bridging syndesmophytes) [2,3] Complications: - dysphagia - unstable vertebral fractures - spinal stenosis - myelopathy Management: - no treatment, none usually necessary

Related

osteoarthritis of the spine osteophyte (bone spur)

General

exostosis; hyperostosis; osteoma; osteoncus

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 832
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16,17, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2022 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Olivieri I, D'Angelo S, Palazzi C, Padula A, Mader R, Khan MA. Diffuse idiopathic skeletal hyperostosis: differentiation from ankylosing spondylitis. Curr Rheumatol Rep. 2009 Oct;11(5):321-8. PMID: 19772826
  4. Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013 Dec;9(12):741-50. PMID: 24189840
  5. Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC. The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in The Netherlands. J Rheumatol. 2008 Aug;35(8):1635-8. Epub 2008 Jun 1 PMID: 18528963