Diffuse Idiopathic Skeletal Hyperostosis (DISH)

What Is the Medical Definition of Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

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.

Is Diffuse Idiopathic Skeletal Hyperostosis (DISH) Hereditary?

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.

What Are the Symptoms of Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

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.

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.

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.

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.

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.

The treatment of DISH involves treating each bothersome symptom. If no bothersome symptoms are present, then no treatment is necessary. The treatment of DISH should be individualized for the patient and their specific signs and symptoms. Physical activity and physical therapy are usually beneficial for patients suffering from spinal stiffness. For example, stretching and gentle exercise generally help with stiffness. Formal physical therapy can include assistance with the appropriate stretching and exercises, as well as modalities such as ultrasound. For those patients with pain that does not respond to exercise and physical therapy, acetaminophen (Tylenol) and NSAIDs (nonsteroidal anti-inflammatory drugs) are frequently very beneficial. These medications may be taken over the counter, unless they are contraindicated due to another medical condition, or prescribed by a health care professional if necessary. A variety of topical medications can be useful for pain, such as capsaicin cream or topical NSAIDs.

A very effective self-care treatment is physical activity. This may include stretching, walking, or swimming. Introduction of a new exercise regimen should always be done gradually and gently.

Heat can be very effective for spinal stiffness. Over-the-counter acetaminophen, ibuprofen (Advil), and naproxen sodium (Aleve) are also frequently helpful.

Patients need to follow up with their health care professional to review the success of current treatments. Some treatments, such as chronic therapy with NSAIDs (nonsteroidal anti-inflammatory medications), need to be monitored by a health care professional.

Frequently the symptoms of DISH can be well controlled with an exercise and stretching regimen alone, with home care modalities such as heat being used as needed. Sometimes medications are necessary for better control of pain and stiffness.

While no scientific studies have been performed on the prevention of DISH, patients with obesity and diabetes are at increased risk of DISH. Therefore, maintaining a healthy weight and a healthy diet high in vegetables, whole grains, lean meats and fruits, and low in added sweeteners, logically should decrease the risk of DISH, as well as a variety of other medical conditions.