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Spine
Diagnosis
Degenerative Diseases and Arthritides
Degenerative Diseases
DISH
DISH
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Diffuse idiopathic skeletal hyperostosis (DISH)

            • Synonyms

              • Forestier disease, senile ankylosing hyperostosis, asymmetrical skeletal hyperostosis
              • Spondylosis hyperostotica, spondylitis ossificans ligamentosa

            • Definitions

              • Flowing coarse osteophytes bridging 4 adjacent vertebral bodies without severe loss of intervertebral disc height and without degeneration of apophyseal and sacroiliac (SI) joints

            IMAGING

            • General Features

              • Radiographic Findings

                • Fluoroscopic Findings

                  • CT Findings

                    • MR Findings

                      • Nonvascular Interventions

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Kuperus JS et al: Criteria for early-phase diffuse idiopathic skeletal hyperostosis: development and validation. Radiology. 291(2):420-6, 2019
                                                2. Murakami Y et al: Association between vertebral fracture and diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976). 44(18):E1068-74, 2019
                                                3. O'Neill KR et al: Risk factors for postoperative retropharyngeal hematoma after anterior cervical spine surgery. Spine (Phila Pa 1976). 39(4):E246-52, 2014
                                                4. Westerveld LA et al: Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 14(5):729-40, 2014
                                                5. Mader R et al: Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 9(12):741-50, 2013
                                                6. Mazières B: Diffuse idiopathic skeletal hyperostosis (Forestier-Rotes-Querol disease): what's new? Joint Bone Spine. 80(5):466-70, 2013
                                                7. Taljanovic MS et al: Imaging characteristics of diffuse idiopathic skeletal hyperostosis with an emphasis on acute spinal fractures: review. AJR Am J Roentgenol. 193(3 Suppl):S10-9, 2009
                                                8. Urrutia J et al: Long-term results of surgical treatment of dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis. Spine J. 9(9):e13-7, 2009
                                                9. Whang PG et al: The management of spinal injuries in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis: a comparison of treatment methods and clinical outcomes. J Spinal Disord Tech. 22(2):77-85, 2009
                                                10. Mader R: Diffuse idiopathic skeletal hyperostosis: a distinct clinical entity. Isr Med Assoc J. 5(7):506-8, 2003
                                                11. Belanger TA et al: Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations. J Am Acad Orthop Surg. 9(4):258-67, 2001
                                                12. Le Hir PX et al: Hyperextension vertebral body fractures in diffuse idiopathic skeletal hyperostosis: a cause of intravertebral fluidlike collections on MR imaging. AJR Am J Roentgenol. 173(6):1679-83, 1999
                                                13. Papakostas K et al: An unusual case of stridor due to osteophytes of the cervical spine: (Forestier's disease). J Laryngol Otol. 113(1):65-7, 1999
                                                14. Cammisa M et al: Diffuse idiopathic skeletal hyperostosis. Eur J Radiol. 27 Suppl 1:S7-11, 1998
                                                15. Ehara S et al: Paravertebral ligamentous ossification: DISH, OPLL and OLF. Eur J Radiol. 27(3):196-205, 1998
                                                16. Mata S et al: A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. Medicine (Baltimore). 76(2):104-17, 1997
                                                17. Weinfeld RM et al: The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol. 26(4):222-5, 1997
                                                18. Van Dooren-Greebe RJ et al: Prolonged treatment with oral retinoids in adults: no influence on the frequency and severity of spinal abnormalities. Br J Dermatol. 134(1):71-6, 1996
                                                19. McCafferty RR et al: Ossification of the anterior longitudinal ligament and Forestier's disease: an analysis of seven cases. J Neurosurg. 83(1):13-7, 1995
                                                20. Nesher G et al: Rheumatologic complications of vitamin A and retinoids. Semin Arthritis Rheum. 24(4):291-6, 1995
                                                21. Burkus JK et al: Hyperextension injuries of the thoracic spine in diffuse idiopathic skeletal hyperostosis. Report of four cases. J Bone Joint Surg Am. 76(2):237-43, 1994
                                                22. Mata S et al: Chest radiographs as a screening test for diffuse idiopathic skeletal hyperostosis. J Rheumatol. 20(11):1905-10, 1993
                                                23. Ramos-Remus C et al: Radiologic features of DISH may mimic ankylosing spondylitis. Clin Exp Rheumatol. 11(6):603-8, 1993
                                                24. Schlapbach P et al: Diffuse idiopathic skeletal hyperostosis (DISH) of the spine: a cause of back pain? A controlled study. Br J Rheumatol. 28(4):299-303, 1989
                                                25. Resnick D et al: Association of diffuse idiopathic skeletal hyperostosis (DISH) and calcification and ossification of the posterior longitudinal ligament. AJR Am J Roentgenol. 131(6):1049-53, 1978
                                                26. Resnick D et al: Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 119(3):559-68, 1976
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Diffuse idiopathic skeletal hyperostosis (DISH)

                                                          • Synonyms

                                                            • Forestier disease, senile ankylosing hyperostosis, asymmetrical skeletal hyperostosis
                                                            • Spondylosis hyperostotica, spondylitis ossificans ligamentosa

                                                          • Definitions

                                                            • Flowing coarse osteophytes bridging 4 adjacent vertebral bodies without severe loss of intervertebral disc height and without degeneration of apophyseal and sacroiliac (SI) joints

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • Fluoroscopic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Nonvascular Interventions

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Kuperus JS et al: Criteria for early-phase diffuse idiopathic skeletal hyperostosis: development and validation. Radiology. 291(2):420-6, 2019
                                                                                              2. Murakami Y et al: Association between vertebral fracture and diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976). 44(18):E1068-74, 2019
                                                                                              3. O'Neill KR et al: Risk factors for postoperative retropharyngeal hematoma after anterior cervical spine surgery. Spine (Phila Pa 1976). 39(4):E246-52, 2014
                                                                                              4. Westerveld LA et al: Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 14(5):729-40, 2014
                                                                                              5. Mader R et al: Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 9(12):741-50, 2013
                                                                                              6. Mazières B: Diffuse idiopathic skeletal hyperostosis (Forestier-Rotes-Querol disease): what's new? Joint Bone Spine. 80(5):466-70, 2013
                                                                                              7. Taljanovic MS et al: Imaging characteristics of diffuse idiopathic skeletal hyperostosis with an emphasis on acute spinal fractures: review. AJR Am J Roentgenol. 193(3 Suppl):S10-9, 2009
                                                                                              8. Urrutia J et al: Long-term results of surgical treatment of dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis. Spine J. 9(9):e13-7, 2009
                                                                                              9. Whang PG et al: The management of spinal injuries in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis: a comparison of treatment methods and clinical outcomes. J Spinal Disord Tech. 22(2):77-85, 2009
                                                                                              10. Mader R: Diffuse idiopathic skeletal hyperostosis: a distinct clinical entity. Isr Med Assoc J. 5(7):506-8, 2003
                                                                                              11. Belanger TA et al: Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations. J Am Acad Orthop Surg. 9(4):258-67, 2001
                                                                                              12. Le Hir PX et al: Hyperextension vertebral body fractures in diffuse idiopathic skeletal hyperostosis: a cause of intravertebral fluidlike collections on MR imaging. AJR Am J Roentgenol. 173(6):1679-83, 1999
                                                                                              13. Papakostas K et al: An unusual case of stridor due to osteophytes of the cervical spine: (Forestier's disease). J Laryngol Otol. 113(1):65-7, 1999
                                                                                              14. Cammisa M et al: Diffuse idiopathic skeletal hyperostosis. Eur J Radiol. 27 Suppl 1:S7-11, 1998
                                                                                              15. Ehara S et al: Paravertebral ligamentous ossification: DISH, OPLL and OLF. Eur J Radiol. 27(3):196-205, 1998
                                                                                              16. Mata S et al: A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. Medicine (Baltimore). 76(2):104-17, 1997
                                                                                              17. Weinfeld RM et al: The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol. 26(4):222-5, 1997
                                                                                              18. Van Dooren-Greebe RJ et al: Prolonged treatment with oral retinoids in adults: no influence on the frequency and severity of spinal abnormalities. Br J Dermatol. 134(1):71-6, 1996
                                                                                              19. McCafferty RR et al: Ossification of the anterior longitudinal ligament and Forestier's disease: an analysis of seven cases. J Neurosurg. 83(1):13-7, 1995
                                                                                              20. Nesher G et al: Rheumatologic complications of vitamin A and retinoids. Semin Arthritis Rheum. 24(4):291-6, 1995
                                                                                              21. Burkus JK et al: Hyperextension injuries of the thoracic spine in diffuse idiopathic skeletal hyperostosis. Report of four cases. J Bone Joint Surg Am. 76(2):237-43, 1994
                                                                                              22. Mata S et al: Chest radiographs as a screening test for diffuse idiopathic skeletal hyperostosis. J Rheumatol. 20(11):1905-10, 1993
                                                                                              23. Ramos-Remus C et al: Radiologic features of DISH may mimic ankylosing spondylitis. Clin Exp Rheumatol. 11(6):603-8, 1993
                                                                                              24. Schlapbach P et al: Diffuse idiopathic skeletal hyperostosis (DISH) of the spine: a cause of back pain? A controlled study. Br J Rheumatol. 28(4):299-303, 1989
                                                                                              25. Resnick D et al: Association of diffuse idiopathic skeletal hyperostosis (DISH) and calcification and ossification of the posterior longitudinal ligament. AJR Am J Roentgenol. 131(6):1049-53, 1978
                                                                                              26. Resnick D et al: Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 119(3):559-68, 1976