Diffuse idiopathic skeletal hyperostosis

Abstract

Based on etiopathogenic and clinical considerations, the diffuse idiopathic skeletal hyperostosis (DISH) represents a disease state different from OA. It is frquently discussed as an OA variant. The disease is characterized by an unusual type of florid hyperostosis of the spine with large spurs or marginal bony proliferations in the form of anterior osseous ridges. Ossification occurs in the connective tissue of the anterior longitudinal ligament and the peripherial disc margins. Physicians recognize 3 syndromes associated with this phenomenon: 1) Forestier disease, 2) ossification of the posterior longitudinal ligament - OPLL, and 3) ossification of the vertebral arch ligaments - OVAL. The diffuse radiographic findings involving both spinal and extraspinal structures have led to the suggestion that this disorder represents an "ossifying disease" rather than a localized disorder of the spine. Various common metabolic conditions such as diabetes mellitus, dyslipidemia and hyperuricemia have been found in 70% of the DISH population.