Forestier’s Disease / DISH
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition commonly affecting the spine characterized by calcification (bony hardening) of ligaments, tendons and joint capsule insertions. Usually the upper portion of the back (thoracic spine) is affected, but it may also involve the neck (cervical spine) and lower back (lumbar spine). In a few cases, the elbow, patella, calcaneus, and hip and knee joints may also be affected. The etiology remains unknown.
Diffuse idiopathic skeletal hyperostosis is more common among individuals older than 50 years of age with a male predominance. Diffuse idiopathic skeletal hyperostosis is often asymptomatic and is detected on unsuspected X-rays or CT/MRI scans. Some patients may complain of pain, stiffness, and loss of range of motion. DISH is usually associated with osteoarthritis. Individuals with diffuse idiopathic skeletal hyperostosis tend to have a higher body mass index, elevated uric acid levels and a higher tendency to develop diabetes mellitus.
A doctor may recommend imaging tests such as X-rays, CT and MRI scans for the diagnosis of DISH. The calcification of ligaments, particularly of the anterior longitudinal ligament, has a distinct appearance of candle wax dripping down your spine.
You may be prescribed non-steroidal anti-inflammatory drugs for pain relief. Chiropractic manipulation may also be beneficial. Arthroplastic surgery may be considered in patients with ossification around hip and knee joints.
A few patients with DISH may develop the following complications:
- Myelopathy (spinal cord compression)
- Rarely, dysphagia may result from the pressure of the overgrown ligamentous calcification on the esophagus
- Cervical compression due to formation of osteophytes in the cervical spine
- Rarely, osteophytes in the thoracic spine can compress bronchii, the larynx and trachea, and the inferior vena cava.
- Vertebral fractures may result from reduced flexibility of the vertebral column