Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Diffuse Idiopathic Skeletal Hyperostosis (DISH) Facts
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that causes bone to form in abnormal places. DISH most commonly affects the mid back (thoracic spine) but may also affect the neck (cervical spine), low back (lumbar spine), hips, heels, and other areas. DISH is also known as Forestier's disease, spondylitis ossificans ligamentosa, spondylosis hyperostotica, and ankylosing hyperostosis of the spine. The exact cause of DISH is not known. DISH is more common in men than women and the elderly. DISH is uncommon before age 40. Decreased range of motion of the spine, especially in the mid back, is the most common sign of DISH. The diagnosis of DISH is made using X-rays. The treatment of DISH involves treating each bothersome symptom, if there are any.
Diffuse Idiopathic Skeletal Hyperostosis Causes
The exact cause of DISH is not known. A variety of factors are thought to contribute to its development, such as metabolic conditions. For example, DISH is more common in obese people and those with diabetes, as well as up to 20% of people with acromegaly (a rare condition caused by abnormal levels of growth hormone). It is more common in men than women and the elderly. DISH is uncommon before age 40.
Diffuse Idiopathic Skeletal Hyperostosis Symptoms and Signs
Decreased range of motion of the spine, especially in the mid back, is the most common sign of DISH. DISH commonly causes pain in the affected area. For example, neck pain is common in people with DISH in the cervical spine (the spine in the neck).
If large bone spurs form in the neck, they can rarely cause difficulty breathing or trouble swallowing. Very rarely, large bone spurs in the neck or elsewhere in the spine can cause serious complications due to compression of the spinal cord. Bone spurs in the low back can put pressure on the spinal nerves and cause numbness and tingling in the legs.
Other signs of DISH include tenderness over sites where ligaments attach to bones, such as the back of the heel where the Achilles tendon attaches to bone.
The symptoms of DISH can be similar to those seen in other diseases affecting the spine or sites where tendons attach to bone including degenerative disc disease, degenerative spondylosis, ankylosing spondylitis, spondylolisthesis, spondyloarthropathy, and spinal arthritis.
When to Call the Doctor about Diffuse Idiopathic Skeletal Hyperostosis
Call your doctor if you have DISH and develop difficulty swallowing or changes in sensation (such as numbness or tingling) in your arms or legs.
Signs and symptoms of the rare complication of compression of the spinal cord are difficulty walking, loss of bowel or bladder control, and loss of sensation in the groin. These symptoms, while rare, should be evaluated emergently.
Diffuse Idiopathic Skeletal Hyperostosis Diagnosis
The diagnosis of DISH is made using X-rays. In patients with DISH, X-rays show abnormal bone formation along the ligaments of the spine. X-ray findings are most prominent in the thoracic spine of the mid back. Therefore, X-rays of the thoracic spine are often necessary for diagnosis. X-rays may also show abnormal bone formation where ligaments attach to bones.
Medically Reviewed by a Doctor on 11/21/2017
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