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DISH - Diffuse Idiopathic Skeletal Hyperostosis,



Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition of unknown cause that affects between 6% and 12% of the general population of North America.  It is more common in older men, with studies suggesting 25% of men and 15% of women over 50 years of age are affected.  DISH is more common among white populations and is also more frequently seen in patients with type II diabetes mellitus or obesity (especially obesity since childhood).


            The most common feature of DISH is ossification and calcification of the anterior longitudinal spinal ligament.  This means that there is bone formation and growth along the front of the vertebral (spinal) column.  Very frequently the right side of the vertebral column has bony formation as well.  This is related to the anatomical position of the aorta along the spine.  Although it is not as common, the posterior (back) side of the vertebral column can also be a site of bony formation.  This ossification and calcification along the vertebrae occurs most commonly in the lower-thoracic region (the lower middle part of the back) but can also occur in the cervical (neck) region.  DISH may also include bone formation (“spurs”) at sites other than the spine.  It frequently affects places where ligaments and tendons insert, or attach, to the bone.  Specific sites include the knee, heel and elbow


What are the symptoms?  Are there any complications?


            It is thought that the prevalence of DISH has been underestimated because it can frequently cause little to no evident symptoms.  However, it can cause backache or sharp pain when moving, twisting or bending the torso.  It can also cause stiffness, especially stiffness in the morning or after a long period of rest.  Other symptoms resemble tendonitis near an affected joint.  Bone spurs are also very common among people with DISH. 


            In addition to pain and stiffness, the ossification caused by DISH may cause problems by applying pressure on nearby anatomical structures.  Some patients even develop a problem with swallowing called “dysphasia”.  These types of symptoms will vary depending on where the ossification occurs. 


How is DISH diagnosed?  What kinds of treatments are appropriate?


            To diagnose DISH your doctor will want to see a radiograph (x-ray) of your thoracic spine.  Images of the bony proliferations in DISH look like flowing wax or whiskers along the vertebral column, commonly in the anterior (front) region.  Other conditions can sometimes mimic the symptoms of DISH.  In order to discount those as possibilities it is important to make sure there is no sacroiliitis (inflammation or destruction of the joining site between part of your spinal column and part of your hip bone, which is a characteristic feature of conditions called spondyloarthropathies).  Your doctor will also make sure the heights of your disks (the pads between vertebrae) have not diminished.  That suggests degenerative disk disease rather than DISH. 


            There is no cure for DISH but your doctor may recommend drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) to manage any pain or tendonitis-like inflammation.  Examples of NSAIDs are naproxen (Naprosyn®) and ibuprofen (Advil® or Motrin®).  Your doctor should, however, council you about the possibility of stomach bleeding as a side effect of these drugs and may even prescribe another drug to prevent that.  In addition, regular exercise such as walking or stretching can be helpful to people with DISH in managing stiffness and pain symptoms and reducing inflammation.  Finally, patients with DISH may be candidates for surgery if bony growth along their spine impinges on other structures in the area. 



Authors: Katherine Fox, BA, UMDNJ – Robert Wood Johnson Medical School, Piscataway, NJ

            Marc Effron, M.D., Department of Physical Medicine and Rehabilitation, New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York City, NY

Grant Cooper, M.D.

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