Diffuse Idiopathic skeletal hyperostosis (DISH) / Forestier Disease

FACTS

  • bony proliferation at sites of tendinous and ligamentous insertion
  • Typical demographic: White males
  • 97% in thoracic spine
  • sacroiliac joints spared
  • Risk factors:
    • elevated BMI
    • DM
    • elevated serum uric acid
    • elevated GH / insulin

HPI

  • universal ROS
    • dysphagia
    • early morning stiffness
    • globus pharyngis (lump in throat feeling)
    • bulbar symptoms (dysphonia, dyspnea)
 

PHYSICAL EXAM

universal spine exam

IMAGING

  • flowing ossification
  • ossification along anterior or R anterolateral aspects of 4+ continuous vertebrase
  • ossification of ALL involving thoracic spine
A/P
  • Speech evaluation +/- modified barium swallow test for severe dysphagia
  • Cervical osteophytes operative if refractory dysphagia (ACDF w/o the discectomy)