My Orthopaedic Surgeon

Cervical Myelopathy Ossification of the Posterior Longitudinal Ligament and Diffuse Idiopathic Skeletal Hyperostosis: problems in investigation
Annals of the Rheumatic Diseases 1987;46:166-168;
I D Griffiths and T P Fitzjohn
This report describes a patient presenting with a spastic quadriplegia who was found to have both diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. There was a dramatic worsening of his symptoms during a myelogram examination of the neck. It is suggested that computed tomographic imaging of the neck is the preferred investigative procedure if OPLL is suspected as a cause of cervical myelopathy.

Synonyms of Diffuse Idiopathic Skeletal Hyperostosis DISH Diffuse Idiopathic Skeletal Hyperostosis Forestier's Disease Spinal DISH Spinal Diffuse Idiopathic Skeletal Hyperostosis Vertebral Ankylosing Hyperostosis General Discussion Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, affects the ligaments around the spine. Sections of the ligaments turn into bone in this disorder, which is considered to be a form of degenerative arthritis. The conversion of ligamental tissue to bone usually extends along the sides of the vertebrae of the spine. (This may be called flowing calcification.) Also, DISH is associated with inflammation (tendinitis) and calcification of the tendons, especially at the points at which the tendon attaches to the bones. When this happens, the patient is said to have developed bone spurs, especially in the heel and ankles (heel spurs). DISH affects three or more vertebrae that are most often located in the chest or in the spine between the chest and pelvis. It is a disorder of older patients, more often affecting men than women ages 50-60. The disorder is often found in association with diabetes, high blood pressure, heart disease and obesity.

Diffuse idiopathic skeletal hyperostosis (DISH) describes a phenomenon characterized by a tendency toward ossification of ligaments. It most characteristically affects the spine. Ossification of the longitudinal ligaments (especially the anterior ligaments) of the spine produces a tortuous paravertebral mass anterior to and distinct (at least radiologically) from the vertebral bodies. Grossly, the appearance is that of candle wax dripping down the spine. While the thoracic anterior longitudinal ligament is ossified, the areas of ossification often meet without fusion. Motion actually is possible, in contrast to lumbar vertebral bridging, which is associated with loss of lumbar motion. The zygapophyseal and sacroiliac joints are not involved in DISH, and the intervening intervertebral disk space is preserved.

Paraspinal ligaments undergo degeneration, secondary to attrition, and often ossify. This condition is broadly termed spinal enthesopathy. Physicians recognize 3 syndromes associated with this phenomenon, including (1) Forestier disease (most common; involving anterior longitudinal ligaments) and a more diffuse variant (exhibiting additional extra-axial features) that is termed diffuse idiopathic skeletal hyperostosis (DISH), (2) ossification of the posterior longitudinal ligament (OPLL), and (3) ossification of the vertebral arch ligaments (OVAL). Clinically, DISH is often referred to as senile ankylosing spondylitis because of similarities in appearance between these two conditions, despite the differing ages of onset.

Diffuse idiopathic skeletal hyperostosis aka/or DISH aka/or Forestier disease aka/or Forrestier's disease (sic) aka/or Ankylosing vertebral hyperostosis may cause or feature - Miscellaneous syndromes Hyperostosis Symptoms and Signs Arthropathy Back pain Dysphagia Dysphonia Stridor X-ray abnormalities Spondylitis Orthopaedic conditions Spondylitis Diffuse idiopathic skeletal hyperostosis: Definition(s) via UMLS "A disease of elderly men characterized by large osteophytes that bridge vertebrae and ossification of ligaments and tendon insertions."

Wheeless' Textbook of Orthopaedics
also known as Forestier's disease; - disease involves non-marginal syndesmophytes present at at three successful vertebral levels; - commonly there will be no disc & joint narrowing & nor osteoarthritis; - differentiated from AS, w/ marginal syndesmophytes; - more common in elderly men; - DISH is associated w/ low back pain and is more common in patients w/ diabetes and gout; - prevelance of DISH may be as high as 28%;