Diffuse idiopathic skeletal hyperostosis (DISH) is a tendency for ossification of ligaments, tendons and joint capsule insertions, most often affecting the spine. Calcification of the longitudinal ligaments (particularly anterior) can often produce the radiological appearance of 'wax dripping from a candle', distinct from the vertebral bodies. The thoracic spine is mainly affected but it can also affect the lumbar and cervical spine, and other areas of the skeleton.
The prevalence may be as high as 28%. Elderly men are most commonly affected. DISH often co-exists with osteoarthritis. 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 is present in approximately 19% of men older than 50 years but is found in only 4% of women in this age group. Diffuse idiopathic skeletal hyperostosis (DISH) is uncommon in patients younger than 50 years and is extremely rare in patients younger than 40 years.
Clinical features vary from monoarticular synovitis to dysphagia and even airway obstruction. Is often asymptomatic and discovered by chance on X-rays or CT/MRI scans. Symptoms may include pain, stiffness and restricted movements of the affected areas. Osteophytes may rarely cause symptoms by mechanical compression or by causing an inflammatory reaction. When an upper segment of the cervical spine is involved, particular at the C3-C4 level, the larynx may be affected. This could be result of hoarseness, stridor, laryngeal stenosis and obstruction.
Treatment for pain caused by DISH is similar to that of other joint ailments. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others). More severe pain can be treated with corticosteroid injections. Physical therapy can reduce the stiffness associated with DISH. Surgery may be required in rare cases when diffuse idiopathic skeletal hyperostosis causes severe complications. Surgery may also relieve pressure on the spinal cord caused by diffuse idiopathic skeletal hyperostosis.