DISH Spine Disease

Overview

Diffuse Idiopathic Skeletal Hyperostosis is the actual name for the condition that is understandably often referred to by the abbreviation DISH. While the condition can affect other areas of the skeleton, it predominantly involves the spine. DISH is a fairly common condition. You probably know someone with DISH or you may have received the diagnosis yourself.

Identification

This condition is characterized by calcification and ossification of ligaments. The most commonly affected ligaments run along the front of the spine. The appearance of these ossified ligaments has been likened to dried candle wax. Though often alarming in appearance on an X-ray, DISH may cause very few symptoms, mainly just morning stiffness and achiness. DISH tends to affect more men than women and is usually found in those over age 50. A study published in the journal “Skeletal Radiology” in 1997 found DISH to be present in 25 percent of men and 15 percent of women over the age of 50.

Diagnosis

The diagnosis of DISH spine disease is made entirely on the basis of X-ray findings and may be discovered incidentally on an X-ray taken for other reasons. There are three specific diagnostic criteria used to make the diagnosis:
1. “Flowing” calcification and ossification along the front of at least four contiguous vertebrae.
2. Relatively normal disk thickness with little evidence of degenerative arthritic changes.
3. Noninvolvement of the sacroiliac (pelvic) joints or the facet joints on the backside of the spine.
These criteria were first introduced by Dr. Donald Resnick, author of the text “Bone and Joint Imaging.”

Cause

The term “idiopathic” (the “I” in DISH) literally means “of unknown cause.” Some researchers have noted an association of DISH with adult-onset (type 2) diabetes. This association is not particularly strong and does not specifically reveal a cause-effect relationship. Likewise, the fact that DISH is more common in men has not led to a better understanding of the cause.

Complications

The most frequently encountered complication from DISH is dysphagia, or difficulty swallowing. This occasionally occurs when the ligaments in the front part of the neck vertebrae form such a thick area of ossification that the esophagus (food pipe) is somewhat displaced. In rare cases, when the dysphagia becomes severe, surgery may become necessary.

Treatment

Most cases of DISH do not require any treatment. The condition is not life-threatening and is generally not overly painful or disabling. The Merck Manual of Geriatrics recommends conservative treatment on a symptomatic basis. Massage, physical therapy or over-the-counter analgesics may be appropriate. Since ossification of ligaments gradually leads to loss of joint mobility, it makes sense to try to maintain flexibility through stretching and other gentle exercise.

About this Author

Ron Rogers, a Washington chiropractor, has worked with local and national regulatory bodies in his profession and has provided consultation to the national chiropractic licensing board. He is recognized by the National Strength and Conditioning Association as a certified strength and conditioning specialist. Rogers’ works have been published in several peer-reviewed professional journals, covering topics ranging from musculoskeletal diagnosis to research-based rehabilitation strategies.