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Diffuse Idiopathic Skeletal Hyperostosis (DISH)

by Dr. David Borenstein M.D. updated 09/21​

DISH syndrome is frequently confused with ankylosing spondylitis (AS) since both disorders calcify structures around the spine.  DISH does not affect the sacroiliac joints while AS starts in those joints.  DISH is characterized by spinal stiffness and pain.  The disorder causes bone to form in the anterior portion of the spine, missing the facet joints.

DISH occurs in about 25% of individuals older than 50 years of age.  The ratio of men to women is 2 to 1.  The disease occurs more commonly in Caucasians, and rarely in other ethnic groups.  The cause of the illness is unknown.

What are the Symptoms of DISH?

About 80% of DISH patients complain of spinal stiffness.  Morning stiffness lasts less than an hour.  The most common spinal location is the chest.   A smaller number of patients have neck pain as their initial complaint.  Individuals with neck involvement may have difficulty swallowing if anterior osteophytes are adequately enlarged to block the esophagus.  DISH is a skeletal  disease without other organ involvement.

How is DISH Diagnosed?

The diagnosis of DISH is based on the presence of characteristic radiographic changes  and the absence of clinical findings of another illness.  The radiographic findings include flowing over 4 contiguous vertebrae usually n the thoracic spine, preservation of disc height, and the absence of facet joint fusion.  Patients are HLA-B27 negative.

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How is DISH Treated?

The goal of treatment is to decrease pain to improve motion.  Exercise programs encourage maximal range of motion.  NSAIDs may be helpful in increasing motion by decreasing pain.  For individuals with severe difficulty eating, surgical removal of anterior osteophytes is possible.