[Diffuse idiopathic skeletal hyperostosis in the dog (DISH): a review]. / Diffuse idiopathische skelettale Hyperostose (DISH) beim Hund: Eine Übersicht.

INTRODUCTION: Diffuse idiopathic skeletal hyperostosis (DISH) is a common, non-inflammatory, systemic disease of the spine and the abaxial skeleton in humans and dogs. Spondylosis deformans (SD) must be considered as an important differential diagnosis which in humans, unlike DISH, is always accompanied by degenerative disc disease. In the veterinary literature, usually no difference is made between these diseases. The aim of the present review is to summarize essentials of DISH regarding its definition, etiology, prevalence, clinical findings and therapy in both, the human and dog. In particular, the various classification schemes and the most important differential diagnoses are discussed. Specific aspects of canine DISH are highlighted.

INTRODUCTION: L'hyperostose squelettique idiopathique diffuse (DISH) est une affection systémique non-inflammatoire de la colonne vertébrale et du squelette périphérique chez l'homme et le chien. La spondylose déformante (SD) qui, chez l'homme, contrairement à la DISH, s'accompagne d'une atteinte dégénérative des disques intervertébraux et représente donc une entité pathologique propre constitue un diagnostic différentiel important. Dans la littérature vétérinaire, par contre, on ne distingue souvent pas de façon explicite entre SD et DISH. Le but du présent travail est de donner un aperçu de la définition, de l'étiologie, de la prévalence, de la clinique et du traitement de la DISH chez l'homme et le chien. On discute en particulier les divers schémas de classification et les principaux diagnostics différentiels et on relève particulièrement les aspects spécifiques de l'affection chez le chien.

[Diffuse idiopathic skeletal hyperostosis]. / Difuzní idiopatická skeletární hyperostóza.

Diffuse idiopathic skeletal hyperostosis is a progressive non-inflammatory bone and entheses disease which reduces the quality of life and self-sufficiency of patients. Despite significant prevalence is awareness of this disease still low and often leads to misdiagnosis. Therapeutic approach is different in diseases with similar symptomatology so it is important to raise awareness of this disease.

[Diffuse idiopathic skeletal hyperostosis: current aspects of diagnostics and therapy]. / Diffuse idiopathische skelettale Hyperostose: Aktuelles zur Diagnostik und Therapie.

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the middle-aged and elderly population, characterized by ankylosing formations of the spine and ossifications of peripheral ligaments, tendons and joint capsule insertion points (entheses). Despite the increase of prevalence with age, the condition often remains undiagnosed. It can be an asymptomatic incidental radiographic finding but can also manifest in several multiorgan complications, such as back and neck pain, restriction of mobility of the spine, peripheral joint affection, dysphagia, dyspnea, foreign body sensation, hoarseness, neurologic manifestations due to compression of the spinal cord, hyperuricemia, obesity, hypercholesterinemia and resulting cardiovascular comorbidities, implicating a multidisciplinary approach. The following article presents a current overview of the condition.

Outcomes following conservative treatment of extension fractures in the setting of diffuse idiopathic skeletal hyperostosis: is external orthosis alone a reasonable option?

OBJECTIVE: Extension fractures in the setting of diffuse idiopathic skeletal hyperostosis (DISH) represent highly unstable injuries. As a result, these fractures are most frequently treated with immediate surgical fixation to limit any potential risk of associated neurological injury. Although this represents the standard of care, patients with significant comorbidities, advanced age, or medical instability may not be surgical candidates. In this paper, the authors evaluated a series of patients with extension DISH fractures who were treated with orthosis alone and evaluated their outcomes. METHODS: A retrospective review from 2015 to 2022 was conducted at a large level 1 trauma center. Patients with extension-type DISH fractures without neurological deficits were identified. All patients were treated conservatively with orthosis alone. Baseline patient characteristics and adverse outcomes are reported. RESULTS: Twenty-seven patients were identified as presenting with extension fractures associated with DISH without neurological deficit. Of these, 22 patients had complete follow-up on final chart review. Of these 22 patients, 21 (95.5%) were treated successfully with external orthosis. One patient (4.5%) who was noncompliant with the brace had an acute spinal cord injury 1 month after presentation, requiring immediate surgical fixation and decompression. No other complications, including skin breakdown or pressure ulcers related to bracing, were reported. CONCLUSIONS: Treatment of extension-type DISH fractures may be a reasonable option for patients who are not candidates for safe surgical intervention; however, a risk of neurological injury secondary to delayed instability remains, particularly if patients are noncompliant with the bracing regimen. This risk should be balanced against the high complication rate and potential mortality associated with surgical intervention in this patient population.

Respiratory presentation of diffuse idiopathic skeletal hyperostosis (DISH): Management and review of the literature.

Background: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of entheses. When localized in the cervical paravertebral region, typical signs and symptoms include stiffness, pain, loss of range of motion, and difficulty swallowing.Clinical Presentation: The authors present two less typical respiratory manifestations of DISH due to cervical osteophytes protrusion and obstruction of the upper airway. The first patient was treated conservatively (application of CPAP during nighttime), while the second required emergency intubation and a combined ENT-neurosurgical operation for the removal of osteophytes.Clinical Relevance: Even though dysphagic symptoms are more frequent, DISH may be a cause of airway obstruction and should be included in the differential diagnosis of respiratory distress and OSA.

Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis.

DISH is a condition characterized by calcification and/or ossification of soft tissues, mainly entheses, ligaments and joint capsules. Its prevalence increases with age and, therefore, DISH is a relatively common entity in the elderly. The classical site of involvement is the spinal column with right anterolateral soft tissue ossification being the most characteristic feature. However, DISH is not limited to the spine, and may affect multiple peripheral sites independently. Extraspinal entheseal ossifications are common and observing their isolated presence may lead to the diagnosis of DISH. Furthermore, hypertrophic or atypical OA observed in joints usually not affected by primary OA has frequently been reported in DISH. Several metabolic derangements and concomitant diseases have been suggested to be associated with DISH including obesity, increased waist circumference, hypertension, dyslipidaemia, diabetes mellitus (DM), hyperuricaemia, metabolic syndrome and an increased risk for cardiovascular diseases. Witnessing the present increase in lifespan, obesity, DM and metabolic syndrome in the Western population, the prevalence of DISH should be expected to rise. In order to increase the awareness for DISH, this review focuses on the extraspinal features of the condition.

Diffuse Idiopathic Skeletal Hyperostosis: A Case with Dysphonia, Dysphagia and Myelopathy.

BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of soft tissues, primarily the ligaments and enthesis. Exuberant osteophyte formation of the anterior longitudinal ligament of the spine is usually found. Among the reported complications of cervical osteophyte, dysphagia is the most frequent symptom, and dysphonia is rare. CASE REPORT A 66-year old male was suffering from progressive dysphonia, dysphagia, and myelopathy. Anterior cervical osteophytes and ossification of the posterior longitudinal ligament (OPLL) was shown on x-ray and computed tomography (CT). He was diagnosed with DISH and the osteophytes were resected. The patient's symptoms gradually improved. CONCLUSIONS DISH may induce varying symptoms and surgical intervention is a good way to relieve these symptoms. We rarely see the symptoms of dysphonia, but we should consult with other professionals, such as otolaryngologist and dietician, when treating DISH patients.

Dysphagia revealing diffuse idiopathic skeletal hyperostosis: report of two cases and literature review.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) also known as Forestier's disease, is a musculoskeletal disorder characterized by the calcification of ligaments essentially the vertebral longitudinal anterior ligament. Men are generally affected. It is often asymptomatic. The most common extra-spinal clinical manifestation of this disease presents as dysphagia followed by respiratory disturbances such as dyspnea and sleep apnea. In this paper we discuss two cases where the patients have experienced progressive dysphagia. Radiological findings were compatible with DISH. The management was based on diet modification and anti-inflammatory medication.

Conservative treatment for stable low-energy thoracolumbar vertebral fractures in nonfused segments among elderly patients with diffuse idiopathic skeletal hyperostosis: A matched case-control study.

Diffuse idiopathic skeletal hyperostosis (DISH) is the spontaneous osseous fusion of the spine with anterior bridging osteophytes. It is well-known that conservative treatment for vertebral fractures of fused segment among DISH spines is associated with worse clinical outcomes. However, the prognosis of conservatively treated stable vertebral fractures in neighboring nonfused segments among DISH spines is still unknown. The purpose of this study was to analyze the results of conservative treatment of stable low-energy thoracolumbar (TL) vertebral fracture in nonfused segments among patients with DISH lesions.A total of 390 consecutive patients who visited an emergency department by ambulance with spinal trauma between 2013 and 2017 were retrospectively reviewed. The diagnosis of DISH was determined based on fused spinal segments with bridging osteophytes in at least 3 adjacent vertebrae. For each case of stable TL vertebral fractures in nonfused segments of the DISH spine, we identified 2 age-, sex-, and fracture lesion-matched non-DISH controls who underwent conservative treatment for low-energy TL vertebral fractures during the same period.Of the 33 identified cases of TL fractures with DISH, 14 met our inclusion criteria. The bony union rates of the DISH group and control group were 57% and 75% at the 3-month follow-up examination (P = .38) and 69% and 100% at the 6-month follow-up examination (P = .02), respectively. Among the 13 patients with fractures below the TL junction, fused segments were not diagnosable based on the initial standard radiographs of the lumbar spine for 61.5% of patients.Although this study design was exploratory and the sample size was small, our results suggest that with conservative treatment, stable fractures in nonfused segments in the DISH spine might have a worse prognosis than ordinary osteoporotic vertebral fractures. The diagnosis of coexisting DISH lesions can be missed when only radiographs of the lumbar spine are used to determine the diagnosis.

Exercise therapy for patients with diffuse idiopathic skeletal hyperostosis.

We evaluated the effect of exercise therapy on back pain, spinal range of motion (ROM), and disability in persons with diffuse idiopathic skeletal hyperostosis (DISH). Persons with symptomatic DISH received a daily exercise program for 24 weeks consisting of mobility, stretching, and strengthening exercises for the cervical, thoracic, and lumbar spine. It included 14 supervised sessions over 8 weeks. Outcomes included visual analogue scales (VAS) for pain, stiffness, and fatigue, 13 spinal measurements, the neck pain and disability scale, the Quebec back pain disability scale, the Bath Spondylitis Functional Index, and the MACTAR patient preference scale. Assessments were made at baseline, 8 weeks, and 24 weeks. Fifteen of 17 completed the study. Comparing week 24 with baseline, Schober's test improved significantly (p = 0.02), and VAS stiffness and left finger-to-floor test demonstrated a trend to improvement (p = 0.07 each). The physical measures, which were expected to improve with the exercise program, all moved in the direction expected, but had p values > 0.10. At 24 weeks, eight (53.3%) participants rated their status as improved, three (20%) as unchanged, and four (27%) were unsure about the benefit. The exercise program designed for DISH and tested in this study led to small improvements in physical measures which achieved significance only for lumbosacral flexion.

DISH syndrome and its role in dysphagia.

The diagnosis and treatment of osteophyte-induced dysphagia can be both challenging and frustrating. DISH is a common finding in the adult population and, like the complaint of dysphagia, increases with age. Clearly, it is a small percentage of cervical osteophytes that present upper aerodigestive difficulties. After excluding other causes of dysphagia, conservative treatment is indicated in the initial management of this disorder and should relieve symptoms in the majority of patients. Surgical management should be reserved for severe and recalcitrant symptoms, and the patient must understand that surgery does not guarantee complete resolution of symptoms. Special thanks to Jerry Basto for his assistance in manuscript preparation.

Diffuse idiopathic skeletal hyperostosis: a distinct clinical entity.

Diffuse idiopathic skeletal hyperostosis is often incorporated into osteoarthritis. Although DISH often coexists with OA, patients affected by this disorder differ from patients with primary OA in several aspects: prevalence in the general population, gender distribution, anatomic site of primary involvement, magnitude and distribution in the spine and the peripheral joints. DISH is a distinct clinical entity. Its recognition as such should stimulate clinicians and researchers to focus on its pathogenesis, treatment and prevention.

Diffuse idiopathic skeletal hyperostosis: Forestier's disease.

Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease is characterized by calcification and ossification of soft tissue entheses of ligaments and tendons. DISH is believed to be a variant of osteoarthritis (OA) without the degenerative intervertebral disc and joint degenerative qualities seen in classic OA. The likely pathoetiologic causes of DISH are presented.

[Forestier disease disclosed by dysphagia. Apropos of a case]. / Maladie de Forestier révélée par une dysphagie. A propos d'une observation.

A 74-year-old man presented with a several year history of dysphagia and dysphonia. X-ray examination showed prevertebral ossification, from C2-C3 to C3-C4, associated with a calcification of the anterior longitudinal ligament. The same abnormalities were present in the thoracolumbar spine. There was no hypertrophy nor ankylosis of the articular joints or the sacroiliac articles, and no biological abnormalities. These characteristics are typical of Forestier's disease also named "diffuse idiopathic skeletal hyperostosis (DISH)". Because of the consequences of dysphagia, an operation was carried out with a good result at two months. Symptomatic forms of Forestier's disease are uncommon, but in some cases, surgery is indicated because of the importance of dysphagia and respiratory disturbances. The role of direct compression of the esophagus or the pharynx by the ossification is possible but an associated inflammatory reaction cannot be excluded.

[Forestier-Rotes Querol syndrome]. / Síndrome de Forestier-Rotes Querol.

The diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease is characterized by an hyperostosis of the anterolateral margin of the vertebral bodies. It is an uncommon cause of dysphagia in old patients. In the differential diagnosis of mechanical dysphagia we must have present this disease. Cervico-dorsal spine radiographies reveal large anterior osteophytes creating pharyngeal encroachment.

[Cervical ankylosing hyperostosis as a cause of dysphagia. A case report and review of the literature]. / Hiperostosis anquilosante cervical como causa de disfagia. Presentación de un caso y revisión de la literatura.

Presenting the case of a 56-year-old man diagnosed of an idiopathic ankylotic hyperostosis, with pronounced osteophytosis of the neck and bulged rear wall of the oropharynx, producing dysphagia as associated ENT symptom. Some clinical, diagnostic and therapeutic aspects of the case are contemplated by the AA.