Diffuse idiopathic skeletal hyperostosis

This condition is characterised by flowing ossification along the anterior aspect of the vertebral bodies extending across the disc space. This occurs in the absence of any degenerative, traumatic or postinfectious changes, i.e. the disc space heights are well maintained and there is no disc space loss. It usually affects Caucasians, with a male predominance it is usually seen in patients in their mid-60s.

Most cases occur in the thoracic and lumbar spine (greater than 90% of cases), with the cervical spine involved in greater than 70% of cases (Fig. 4.32). The sacro-iliac joints are spared which can help to differentiate this condition from ankylosing spondylitis.

Patients may have early morning stiffness and mild limitation of activities. They may also present with dysphagia due to compression of the oesophagus between the prominent flowing osteophytes and the rigid laryngeal structures that commonly calcify as people get older.

This condition is associated with hyperostosis at sites of tendon and ligament attachments to the bone, ligamentous ossification and osteophytosis involving the axial and appendicular skeleton [5]. This is best demonstrated on a lateral radiography of the spine (Fig. 4.33). 193

This condition needs to be distinguished from the previously described 'bamboo spine' seen in ankylosing spondylitis. The sacro-iliac joints are usually spared in DISH, and usually no paravertebral ossification is seen (Fig. 4.34).

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