RESUMO
OBJECTIVE: To observe and describe the development and underlying structure of the spinal manifestations of individuals osteologically diagnosed with DISH (Diffuse Idiopathic Skeletal Hyperostosis), using micro-XCT imaging. MATERIALS: A total of 72 individuals with DISH were identified in two modern skeletal collections in South Africa. METHODS: Vertebral columns affected by DISH were scanned at the micro-focus x-ray computed tomography facility at the Nuclear Energy Corporation of South Africa. Four features were macroscopically examined: (1) the origin of the new bone growth; (2) retention of the original vertebral cortex at the site of the new bone formation associated with DISH; (3) evidence of trabecular bone with or without sclerosis on the anterolateral surface of affected vertebrae; and (4) abnormal areas of osteosclerosis beyond features associated with DISH. RESULTS: Considerable variation across and between the four recorded features was found. Of note, 81% (n = 58) of individuals had both developed trabecular bone within the flowing new bone formation (feature 3), without retention of the original vertebral cortex (feature 2). CONCLUSIONS: Possible localised erosive/inflammatory processes destroyed the original cortex of the vertebral body and resulted in the expansion of trabeculae with new bone formation. SIGNIFICANCE: Micro-XCT imaging shed new light on the development of DISH, adding to literature suggesting that it could be an inflammatory disease. LIMITATIONS: Clinical histories of the individuals were not known. SUGGESTIONS FOR FURTHER RESEARCH: The role of chronic inflammatory disease in the development of DISH should be further explored including both the extra-spinal and spinal manifestations.