Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is common spinal enthesopathy affecting approximately 3% to 30% of men older than the age of 50 years. The diagnosis is made radiographically by the (1) presence of flowing osteophytes on the anterolateral margin of at least 4 consecutive vertebral bodies, (2) the preservation of disc height, and (3) the lack of changes associated with sponydloarthropathy or degenerative arthritis. DISH most commonly affects the thoracic spine but also is found in the cervical and lumbar spine. Patients may present with back pain and axial stiffness, but they often are asymptomatic. Most significantly, patients with DISH, even if they are asymptomatic, are at increased risk for severe spinal cord injury even with minimal spinal trauma.