Diffuse idiopathic skeletal hyperostosis DISH or Forestier’s disease; non inflammatory condition

Diffuse Idiopathic Skeletal Hyperostosis (DISH) / Forestier’s Disease DISH is a non-inflammatory systemic condition characterized by abnormal calcification and ossification of ligaments and entheses (sites where tendons and ligaments attach to bone), most prominently along the spine. It was first described by Forestier, hence the alternate name Forestier’s disease. 🔎 Key Features Definition: Ossification of spinal ligaments, especially the anterior longitudinal ligament, leading to flowing bony bridges across vertebrae. Age group: Typically affects older adults (greater than 50 years). Sex: More common in men. Sites involved: Spine (thoracic most common, then lumbar and cervical). Extraspinal enthesopathies (pelvis, calcaneus, elbows, knees). 🩺 Clinical Presentation Often asymptomatic and discovered incidentally on X-ray. Symptoms when present: Spinal stiffness (especially thoracic). Reduced range of motion. Back pain (usually mild compared to ankylosing spondylitis). Dysphagia (difficulty swallowing) if cervical spine is involved. No sacroiliac joint involvement (helps differentiate from ankylosing spondylitis). 📊 Radiological Features Flowing ossification along the anterior aspect of ≥4 contiguous vertebrae. Preservation of disc height (unlike degenerative disc disease). Absence of sacroiliitis (distinguishes from ankylosing spondylitis). Extraspinal calcification at entheses (heel spurs, pelvic ossifications). ⚕️ Etiology & Risk Factors Exact cause unknown (“idiopathic”). Associated with: Metabolic syndrome (obesity, diabetes, hyperlipidemia). Mechanical stress. Genetic predisposition. 🧪 Diagnosis X-ray spine: Classic “flowing candle wax” appearance of ossification. CT/MRI: Helpful for assessing complications (e.g., spinal cord compression). Clinical correlation: Rule out ankylosing spondylitis and degenerative arthritis. ⚕️ Management Conservative: Analgesics, NSAIDs for pain. Physiotherapy to maintain mobility. Weight reduction and management of metabolic syndrome. #Spinalcord