Diffuse idiopathic skeletal hyperostosis
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Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that results in the calcification of body ligaments and tendons around the spine. This disorder is a type of arthritis that is also known as Forestier’s disease.
These calcified regions can also develop bone spurs, which are abnormal new bone growths that can cause pain, stiffness, and restrict mobility. This typically happens where the tissue and bone are connected.
The thoracic and cervical spine, which make up the upper section of the back and neck, are frequently affected by DISH. DISH can occur anywhere on the body such as hands, knees, hips, heels, and/or ankles.
The management of DISH can involve a range of approaches such as physical therapy, medication, surgery, and the use of heat therapy.
Symptoms
Some DISH patients have no symptoms. X-rays obtained for a different purpose are examined by doctors who find the condition. When DISH symptoms do manifest, they include:
- Stiffness that is common in the morning or evening
- Numbness or tingling sensation in the legs
- Weakness in the legs
- Pain at the upper back or neck
- Pain in the shoulder, elbows, knees, or heels
- Reduced mobility or loss of range of motion
- Difficulty swallowing or hoarseness (abnormal voice changes) if DISH affects the neck.
Symptoms typically appear when the spine’s surrounding nerves start to be compressed by bone spurs.
Causes
DISH is brought on by abnormal bone growth and calcification. An accumulation of calcium salts causes calcification, which results in the hardening of ligaments and tendons. What triggers these conditions is unknown to healthcare providers.
Risk Factors
There are some risk factors that are believed to increase the likelihood for DISH even though the cause is unknown. They consist of:
- Age: People who are 50 and older are at risk to develop DISH. DISH is uncommon for people who are under the age of 40.
- Gender: It is common for men than women.
- Medication: Retinoids, such as those used to treat severe acne, can make someone more susceptible to getting DISH.
- Other diseases: DISH may occur from conditions that alter the metabolism of cartilage, such as diabetes mellitus (high blood sugar) and acromegaly (excessive growth hormone in the body). Have experienced prolonged exposure to high quantities of vitamin A.
Diagnosis
Diagnostic procedures assist healthcare providers in ruling out diseases that present with same symptoms, such as various forms of arthritis.
- Imaging test:
- X-ray: a test that creates images of bones using X-rays, which are invisible electromagnetic energy beams. An evaluation of bone anatomy, vertebral column alignment, and curvature can be obtained through the use of plain film X-rays. It also be used to detect specific skeletal anomalies including bone spurs, disc space narrowing, vertebral body fracture, collapse, or erosion.
- CT scan: a diagnostic imaging process that creates precise images of the body using a combination of x-rays and computer technology. Any aspect of the body, including the bones, muscles, fat, and organs, can be seen in great detail on a CT scan.
- MRI: a diagnostic process that creates precise images of the body’s organs and structures using a mix of big magnetic, radio waves, and computers.
Treatment
The calcification or bone growth linked to DISH cannot be stopped by treatment. Instead, treatment focuses on symptom management and delaying the progression of the illness.
DISH can be treated in the following:
- Hot compress: Warm compresses can help relieving the pain and stiffness.
- Medication: Anti-inflammatory medications, such as non-steroid anti-inflammatory (NSAIDS) medications, are used in treatment. Healthcare providers may also recommend corticosteroid injections, or muscle relaxant medication.
- Physical therapy: Certain exercises can assist increase mobility and minimize stiffness.
- Surgery: Surgery may occasionally be needed to address structural issues with the spine. Patients with neck bone spurs who experience difficulties swallowing may potentially be candidates for surgery.
Surgery to decompress the spinal cord may be necessary if DISH has led to bone spurs in and around the spine and if these bony growths start to press on the spinal cord and/or nerve roots. Moreover, surgery is necessary to correct fractures brought on by DISH. Surgery to decompress the spinal cord may be required if these fractures start to compress the spinal cord and/or nerve roots.
A spinal fusion may be carried out in specific circumstances by the surgeon to guarantee that the spinal column is stable following treatment. In order to allow the bones to fuse together during a spinal fusion, the surgeon may insert a bone in the gap.
