Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier disease is a common condition characterised by bone proliferation at sites of tendinous and ligamentous insertion of the spine affecting elderly individuals. Symptoms of DISH include intermittent pains and stiffness in the areas of the bony changes of the spine and inflamed tendons. DISH is diagnosed when the characteristic flowing calcifications are detected with images of the spine, such as in plain film X-ray methods. Nonsteroidal anti-inflammatory medications (NSAIDs) can be helpful in both relieving pain and inflammation of DISH. DISH most commonly affects the elderly (especially 6th to 7th decades). Its estimated frequency in the elderly is at ~10%. DISH is well represented in the zoologic and paleontologic record. It is found in 1-3% of baboons and monkeys, as well as in gorillas, bears, camels, horses, bison, musk oxen, canids, felids, and whales. DISH was also present in dinosaurs. An age-dependent phenomenon, it occurs in 15-25% of older mammals.
Diffuse idiopathic skeletal hyperostosis (DISH) is present in approximately 19% of men and 4% of women older than 50 years. Frequency information in the US was derived from the study of nonselected skeletal/cemetery populations. The posterior longitudinal ligament of the cervical spine is ossified in 2% of Japanese individuals but in only 0.16% of white persons. The anterior longitudinal ligament is calcified in 24% of patients with posterior longitudinal ligament ossification. Diffuse idiopathic skeletal hyperostosis (DISH) was reported in 17% of individuals in the Netherlands, paradoxically with male predominance. Diffuse idiopathic skeletal hyperostosis (DISH) appears to be a phenomenon rather than a disease. Double-blind controlled evaluation (in which controls and patients were drawn from the same population) revealed no associated pathology. Arthritis, bursitis, and tendinitis appeared no more frequently in patients with DISH than in controls. Any back pain present was no different in character or duration than that noted in control subjects. A history of back injury was actually found to be twice as frequent in control subjects as it was in patients with DISH. Back flexibility was no more limited in patients with DISH than it was in controls. In fact, patients with DISH who had decreased lumbar spinal motion had a lower frequency of back pain, implying that DISH may be protective.[14, 18] One study has showed that DISH may be protective against back pain.
There is no cure for DISH, there are some Non-surgical treatments that can help the symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help manage pain or tendonitis-like inflammation. TylenolÂ® which is also called acetaminophenmay also help relieve pain. More severe pain may be treated with corticosteroid injections. Surgery is necessary in rare conditions. If the extra bone growth compresses the spinal cord or nerve roots, surgery may be needed. Surgery is done to relieve pressure on the spinal cord or nerve roots. Surgery to take out the extra bone growth (spurs) in the neck may help with symptoms of difficulty swallowing. You should expect to be hospitalized for a brief stay. Initially you may be asked to wear a corset or brace for support.