Diffuse Idiopathic Skeletal Hyperostosis of Cervical Spine with Dysphagia-Molecular and Clinical Aspects.

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the calcification and ossification of the ligaments of the cervical spine; in some cases, it may result in dysphagia. The condition is more common in men over 50 years of age with metabolic disorders, and it is often asymptomatic and not a major issue for patients. The etiology of DISH is poorly understood, and known genetic factors indicate multiple signal pathways and multigene inheritance. In this review, we discuss the epidemiological, clinical, and etiological aspects of DISH with a special focus on dysphagia.

Whole Spine CT Scan for the Detection of Acute Spinal Fractures in Diffuse Idiopathic Skeletal Hyperostosis Patients Who Sustained Low-energy Trauma.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to evaluate the role and value of whole-spine computerized tomography (WSCT) versus radiographs and targeted CT to tender spinal regions in patients with diffuse idiopathic skeletal hyperostosis (DISH) after low-energy trauma. SUMMARY OF BACKGROUND DATA: Subjects with DISH are prone to spinal fractures even after low-impact trauma due to a rigid spinal structure. METHODS: One-hundred forty-seven subjects (average age: 83 years, M:F 64/83) with verified DISH (Resnick and Niwayama radiographic criteria) on WSCT who were admitted to the emergency room (ER) after low-energy trauma and for whom there were radiographs of at least the thoracic and lumbar spine were evaluated for the presence of acute spinal fractures on both radiographs and WSCT. Agreement between fracture location and spinal tenderness location (cervical, thoracic, or lumbar) as reported in the medical record was evaluated. RESULTS: Significantly more acute fractures were detected on WSCT compared to radiographs (55 and 32, P < 0.00001, respectively). The site of tenderness was not indicative of the fractured spinal segment in 57% of all acute fractures (seven cervical, 15 thoracic, and 16 lumbar). No fracture was detected on WSCT in 10 subjects with an unspecified pain location. Multilevel distant fractures were detected in two patients with a specified pain location to only one of the fractures. CONCLUSION: WSCT in DISH subjects after low-impact trauma is mandatory due to the high prevalence of acute fractures and the low specificity for fracture detection on radiographs. A targeted CT approach to the tender spinal segment proved to be inadequate and would have missed 57% of the acute single fractures with incompatible spinal tenderness location. These results support the significant role of WSCT in the ER setting for detecting and pinpointing the spinal fracture site of DISH subjects who present with low-impact trauma. LEVEL OF EVIDENCE: 3.

Diffuse idiopathic skeletal hyperostosis in subjects with congestive heart failure undergoing cardiac rehabilitation: A decision tree analysis.

OBJECTIVE: To assess the prevalence of diffuse idiopathic skeletal hyperostosis and its relationship with vascular risk factors among patients with congestive heart failure. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 584 consecutive patients admitted to a Rehabilitative Cardiology Unit. METHODS: Chi-square Automatic Interaction Detector (CHAID) decision tree analysis was used to build a predictive model. RESULTS: The mean age (standard deviation) of the study population was 68.1 years (standard deviation 12.3), and 77.7% of the subjects were men. The overall prevalence of diffuse idiopathic skeletal hyperostosis in the cohort was 49.8%. Logistic regression analysis showed that age was a predictor of diffuse idiopathic skeletal hyperostosis (odds ratio: 1.034; 95% confidence interval 1.021-1.047, p < 0.001), with increasing odds ratios for increasing age tertiles. The CHAID prediction model identified 2 age "buckets": < 69 and ≥ 69 years. Patients ≥ 69 years had a diffuse idiopathic skeletal hyperostosis prevalence of 60.1%, compared with 39.2% among those < 69 years. Notably, body mass index was a predictor of diffuse idiopathic skeletal hyperostosis in this younger subset of patients (p = 0.028), with 2 body mass index "buckets", ≤ 23.3 and > 23.3 kg/m2, the latter showing more than twice the prevalence of diffuse idiopathic skeletal hyperostosis (43.2% vs 20%). CONCLUSION: Diffuse idiopathic skeletal hyperostosis is extremely frequent among patients with congestive heart failure, with age and body mass index being the strongest predictors.

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis.

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of vertebral bodies and peripheral entheses. However, variations in sacroiliac (SI) joint change in patients with DISH have not been fully clarified. The purpose of this study was to evaluate SI joint variation in patients with DISH in comparison with a non-DISH population. METHODS: A total of 342 SI joints in 171 patients (DISH+, n = 86; DISH-, n = 85) who had undergone lumbar spine surgery were analyzed by computed tomography examination. SI joint variations were classified into four types: Type 1, normal or tiny peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophytes formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. The type of bridging osteophyte in SI joints and the prevalence of ossification in each spinal segment from C1 to SI joint were also examined. RESULTS: The most common SI joint variation in the DISH+ group was bony fusion (Type 4), with 71.6% exhibiting anterior paraarticular bridging. On the other hand, SI joint vacuum phenomenon (Type 3) was the most frequent change (57.1%) in the DISH- group. The middle to lower thoracic spine and SI joints were highly affected in DISH and caused bony ankylosis. CONCLUSIONS: Anterior paraarticular bridging was the most common type of SI joint change in patients with DISH who underwent lumbar spine surgery. The present results regarding variations of SI joint changes in DISH should help understand the etiology of DISH.

Prevalence of Diffuse Idiopathic Skeletal Hyperostosis in the General Elderly Population: A Japanese Cohort Survey Randomly Sampled From a Basic Resident Registry.

STUDY DESIGN: This is a Japanese resident cohort study based on a municipal registry. OBJECTIVES: In this study of an aged Japanese population, we used random sampling from the basic resident registry of a rural town for subject selection to investigate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and effect of subject-related factors. SUMMARY OF BACKGROUND: DISH is a condition characterized by the calcification and ossification of soft tissues. Interest is mounting on DISH as the elderly rate increases, but its pathogenetic mechanism remains unknown. DATA: A total of 413 aged people randomly sampled from the resident registry of Obuse town. MATERIALS AND METHODS: We established 8 groups on the basis of age (50s, 60s, 70s, and 80s) and sex after random sampling from the resident registry of Obuse town. A total of 411 participants (202 male and 209 female) were enrolled and underwent a single whole-spine lateral radiographic examination. We assessed for the existence of DISH and analyzed the effects of clinical factors using multivariate analysis. RESULTS: A total of 72 (17.5%) participants were identified to have DISH in our population cohort. The prevalence of DISH tended to increase with age, being 3.1% in subjects in their 50s, 14.0% in their 60s, 24.3% in their 70s, and 29.0% in their 80s. According to multivariate analysis, hypertension (HT), male, bone mineral density (BMD), and aging were independent factors associated with DISH. The odds ratios of HT, male, and BMD were 1.93, 2.88, and 19.1, respectively. CONCLUSIONS: This is the first study examining DISH in detail according to age and sex groups on a general population basis. Multivariate analysis revealed HT, male, BMD, and aging to be independent factors associated with DISH in the healthy community-dwelling elderly.

Comparison of the AOSpine subaxial cervical spine injury classification system and the Allen classification.

The AOSpine group has launched a new subaxial cervical spine injury system (AOSCIS) based on morphology. The objective of this study was to use the AOSCIS and compare it to the widely used Allen classification (AC) based on mechanics for subaxial cervical spine injury. Twenty-two consecutive patients with subaxial cervical spine injury who received posterior cervical fixation in our hospital were included in this study. Medical records were evaluated retrospectively. The evaluated factors were as follows: preoperative ASIA impaired scale (AIS), AOSCIS, AC, and diffuse idiopathic skeletal hyperostosis (DISH). There was AIS A in nine patients, AIS C in four patients, AIS D in four patients, and AIS E in five patients. Two patients with AOSCIS B2 were classified as AC DF1. Two AOSCIS F3 patients were classified as AC CE1. Eighteen AOSCIS C patients were classified into multiple categories: five as AC DF2, three as DF3, one as CF4, one as CF5, four as DE2, three as CE3 + DE1, and one as CE3 + VC2. All of the AOSCIS A0 (F) or B patients were classified as AC stage 1, and all of the AOSCIS C patients were classified as AC stage 2 and higher (P < 0.05). All of six patients with DISH were classified as AOSCIS C and CE3, DE2, or DF3. AOSCIS and AC are correlated. Conducting an evaluation using both systems helps us to better comprehend subaxial cervical spine injuries.

Styloid Process Elongation on Cervical Spine Computed Tomography is Associated with the Enthesopathy-Related Diseases of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis.

BACKGROUND: Enthesopathy may lead to calcification of the stylohyoid ligament and can cause elongation of the styloid process (SP). OBJECTIVES: To evaluate whether SP elongation is associated with two common enthesitis-related diseases: ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). METHODS: Cervical spine computed tomography (CT) examinations of patients with DISH (n=64, Resnick criteria), AS (n=24, New York criteria) and a controls (no radiological signs of DISH or AS, n=54) were retrospectively evaluated. The DISH group was further divided into patients with and without cervical DISH. The length of right and left SP was measured independently by two readers on coronal and sagittal curved reformats. The average right and left styloid length and average length per person were compared among the groups. RESULTS: Demographic characteristics were similar between the DISH and control groups (average age 68.2 ± 15.7, 69.2 ± 12.7 years, male:female ratio 48:16 and 35:19, respectively, P > 0.05), whereas age was significantly lower (average age: 53 ± 15 years, P < 0.0001) in the AS group, which was also composed mainly of men. The AS and DISH groups had significantly longer SP compared to controls (AS 37.9 ± 9.6 mm, DISH 34.4 ± 9 mm, control 30.3 ± 10.1 mm, P < 0.05). There was no correlation between age and SP length. Inter-reader reliability of SP measurements was excellent in all groups (ICC = 0.998, P < 0.0001). CONCLUSIONS: SP elongation is associated with both AS and DISH substantiating the enthesopathy-related pathophysiology of this finding.

The Importance of Recognizing Diffuse Idiopathic Skeletal Hyperostosis for Neurosurgeons: A Review.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcification and ossification of the soft tissues, mainly ligaments and entheses. The spines of patients with DISH generally become increasingly rigid and osteoporotic, and fractures may occur after even a relatively minor traumatic event such as a ground-level fall. Moreover, the prevalence of DISH may be rapidly increasing in affluent societies. Thus, awareness of this condition is becoming more important for neurosurgeons when assessing trauma patients. For the present article, a literature review was conducted to summarize the current clinical, pathogenetic, and therapeutic knowledge of this disease. Furthermore, current treatment strategies for DISH-related spine injuries are also reviewed. Although the recommended treatment for spinal injuries in DISH patients is surgical, mainly through long-segment posterior fusion, rather than conservative options, stable fractures without any associated neurologic deficits have often been successfully managed with immobilization alone. Percutaneous instrumentation and the use of teriparatide may be useful depending on the surgical risks and patient neurological status.

[Surgical treatment for Forestier disease: a report of 8 cases].

OBJECTIVE: To investigate the clinical effects and operative options for the treatment of Forestier disease. METHODS: From June 2005 to May 2012, 8 patients with progressive dysphagia due to Forestier disease were treated through anterior approach, their clinical data were retrospective analyzed. There were 6 males and 2 females, aged from 65 to 83 years old with an average of 73 years. Among the patients, osteophytes removal was performed in 3 cases, osteophytes removal with discectomy and fusion was performed in 2 cases, osteophytes removal with corpectomy and fusion was performed in 3 cases. According to Bazaz dysphagia score to assess the improvement of the patients' symptoms before and after operation. RESULTS: All patients were followed up from 12 to 40 months with the mean of 18.5 months. Seven cases were asymptomatic and 1 case had mild symptom in the last follow-up. Radiographs showed the space enlargement between vertebral body and trachea. CONCLUSION: It is effective to treat patients with progressive dysphagia due to Forestier disease through surgical method. And the operative options depend on the stability of cervical spine and the neurological symptoms of the patients.

Diffuse idiopathic skeletal hyperostosis and central cord syndrome after minor trauma: a case report.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior and lateral ossification of the vertebral body. We present a case report of central cord syndrome in a patient with DISH after minor trauma. The patient was treated surgically. We also discuss symptomatology and the common mechanism of cord injury in DISH.

Spinal hyperostosis in humans and companion animals.

Both spondylosis and diffuse idiopathic skeletal hyperostosis (DISH) are prevalent in humans and are considered distinct entities. Nowadays, the term spondylosis is in the biomedical literature mostly used when also degenerative disc disease is present. In companion animals, many reports on spondylosis, often without intervertebral disc degeneration, are described. The nomenclature and the definitions of both spondylosis and DISH in the biomedical and veterinary literature should be more in line to facilitate comparison. DISH occurs in dogs but has not been described in cats yet. DISH and spondylosis can co-occur in dogs in one animal. Boxers may serve as translational disease models for the elucidation of the gene(s) involved in the (etio)pathogenesis of DISH or serve as a test population for newly developed treatment options.

Rheumatic manifestations of endocrine disease.

PURPOSE OF REVIEW: Musculoskeletal complaints are a feature of several endocrine diseases. This review will update clinicians on their association, presentation, and treatment. RECENT FINDINGS: To update clinicians on the recent literature as it is related to pathophysiology, genetic, and clinical findings on the association of these diseases and musculoskeletal complaints. SUMMARY: Rheumatologists in the clinic are faced with different presentations of various musculoskeletal complaints every day. Every new patient encounter requires the differential diagnosis of these complaints. The first task is usually to decide with what disease in internal medicine these complaints are associated. The endocrinopathies are a group of illnesses that either present initially or exhibit sometime during the course of the disease as a variety of musculoskeletal complaints. Rheumatic manifestations may often be the initial presentation of an endocrine disorder. Each endocrine disorder may also have its own arthritic complaints, which can present as a definitive rheumatic disease such as calcium pyrophosphate dihydrate deposition disease or as a rheumatic symptom such as diffuse arthralgia. The rheumatologist as well as the primary care physician should be knowledgeable about the ways in which muscles, tendons, ligaments, and joints are affected by diseases of the endocrine system.

The aetiology behind torticollis and variable spine defects in patients with Müllerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome: 3D CT scan analysis.

The aim of the article is fourfold; firstly, to detect the aetiology of torticollis in patients with Müllerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome; secondly, spine pathology in Müllerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome varies considerably from one patient to another and there are remarkable differences in severity and localization; thirdly, mismanagement of congenital spine pathology is a frequent cause of morbid/fatal outcome; and fourthly, the application of prophylactic surgical treatment to balance the growth of the spine at an early stage is mandatory. Reformatted CT scans helped in exploring the craniocervical and the entire spine in these patients. The reason behind torticollis ranged between aplasia of the posterior arch of the atlas, assimilation of the atlas and extensive fusion of the lower cervical vertebrae (bilateral failure of segmentation) in four patients; in one patient, in addition to the hypoplastic posterior arch of the atlas, we observed ossification of the anterior and the posterior longitudinal spinal ligaments giving rise to a block vertebrae-like suggestive of early senile ankylosing vertebral hyperostosis (Forestier disease). Scoliosis at different spine levels was attributable to variable spine defects. Pelvic ultrasound showed the classical renal agenesis in four patients; whereas in one patient, the MRI showed pelvic cake kidney (renal fused ectopia) associated with ovarian, uterine and vaginal abnormalities. This is the first exploratory study on the craniocervical and the entire spine in a group of patients with MURCS association.

Hyperostosing meningiomas of the cranial vault with and without tumor mass.

OBJECTIVE: This study represents the first clinical series in the reported literature exclusively concentrating on the clinicoradiological features of non-sphenoidal hyperostosing meningiomas. It attempts to identify the factors that may have an impact on the surgical strategy and results of this unique subgroup of meningiomas. METHODS: In the vault, we distinguished between meningiomas with and without tumor mass according to their thickness (<1.5 vs ≥ 1.5 cm) and between convexity (lateral) and calvarial (midline) meningiomas according to their location. The clinical, radiological, surgical and prognostic characteristics of the tumors were examined. RESULTS: Over a 10-year period, we observed 24 cases, 18 of which in the convexity (nine without and nine with tumor mass) and six calvarial (one without and five with tumor mass). Six patients presented with neurological signs, while the majority showed bony hyperostosis (n = 19). Brain edema (n = 7) was found only in cases with tumor mass, in all neurologically impaired patients, and only in one intact patient. Total removal was obtained in 92% patients. Small residual tumors attached to the superior sagittal sinus and perisinusal dura were coagulated in situ and not excised. Morbidity occurred in three symptomatic patients with tumor mass and brain edema (mental confusion in one case and hemiparesis in two cases). Mortality was nil. After a mean follow-up of 4.8 years, three cases relapsed, all of which had initially presented with atypical meningiomas. CONCLUSIONS: The rare hyperostosing cranial vault meningiomas may be classified as being with and without tumor mass. A number of categorical differences exist in their distribution, pattern of hyperostosis, surrounding arachnoidal plane, and their prognosis. Careful preoperative planning aimed at tailoring the extent of tumor removal and reconstruction in the neighboring infiltrated structures enables a good outcome to be achieved.

Diffuse idiopathic skeletal hyperostosis in ancient clergymen.

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral enthesopathies are present. The etiology of DISH is unknown but previous studies have shown a strong association with obesity and insulin-independent diabetes mellitus. DISH can lead to back pain, dysphagia, myelopathy, musculoskeletal impairment and grossly unstable spine fractures after minor trauma. In archeological studies a high prevalence of DISH has been demonstrated in ancient clergymen. The present study describes the pathological changes of human remains excavated from the abbey court (Pandhof) in the city of Maastricht, The Netherlands. Human remains of 51 individuals buried between 275 and 1795 CE: were excavated and examined. The remains were investigated according to a standardized physical anthropological report and individuals demonstrating ossification of spinal ligaments and/or multiple peripheral enthesopathies were included in the study group. The authors reviewed all available material and after reaching consensus, each abnormality found was given a diagnosis and subsequently recorded. After examination, 28 individuals were considered to be adult males; 11 adult females; three adults of indeterminate sex and nine individuals were of sub adult age. The mean age at death for adults was 36.8 years. Seventeen adult individuals (40.4% of all adults), displayed ossifications of at least four contiguous spinal levels and/or multiple enthesopathies of the appendicular skeleton and were therefore, assigned the diagnosis DISH. The mean age of these individuals was 49.5 +/- 13.0 years. In at least three of these individuals, DISH had led to extensive ossification and subsequent ankylosis of axial and peripheral skeletal structures. In this population of (presumably) clergymen and high-ranking citizens, DISH was observed in unusual high numbers at a relatively young age. Some of the examined cases suggest that DISH may be a seriously incapacitating disorder when the more advanced stages of the disease have been reached. It is hypothesized that "a monastic way of life" can predispose to DISH. Present demographic trends in obesity and diabetes mellitus as potential co-factors for the development of DISH warrant further study to investigate its future prevalence.

New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis).

PURPOSE OF REVIEW: Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease is a common disorder among older adults. The diagnosis is based solely on radiographic abnormalities defined using the Resnick criteria. DISH is characterized by ossification of the anterior longitudinal ligament of the spine and various extraspinal ligaments. DISH often coexists with OA, but 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. Purpose of this review is to summarize new clinical, pathogenetic and therapeutic insights of this disease. RECENT FINDINGS: Recent studies confirm that patients with DISH have a greater body mass index, higher serum uric acid levels and are more likely to have diabetes mellitus. In addition, DISH is most probably related to abnormal bone cell growth/activity reflecting the influence of metabolic factors that lead to new bone formation. Serum matrix Gla protein may be a marker of osteometabolic syndromes, such as DISH, that cause hyperostosis. SUMMARY: Many recent developments of DISH are described in this review. Possible pathogenetic mechanism driving bone deposition are discussed. DISH is still recognized radiographically; no specific drug has been yet identified.

Acromegalic axial arthropathy: a clinical case-control study.

Arthropathy is the major cause of morbidity in acromegaly. To feature the spinal involvement, 54 patients with active acromegaly (27 men, 27 women; age range, 21-69 yr) and 54 sex-, age-, and body mass index-matched healthy controls were enrolled in this observational analytical prospective case-control study. A questionnaire to describe onset, duration, and severity of articular symptoms; rheumatological examination, including vertebral and chest mobility, Schober test, thorax expansion, and axial radiological study; and IGF-I, GH, insulin, and glucose level measurement (baseline and after an oral glucose tolerance test) was used to investigate the prevalence of arthropathy and correlate these findings with hormonal parameters. Axial arthropathy was found in 28 patients (52%) and 12 controls (22%; chi(2) = 8.9; P = 0.003). In detail, spinal mobility was reduced in 30 patients (56%) and 10 controls (18%; chi(2) = 14.3; P < 0.0001), thoracic cage was involved in six patients (11%), alterations of spinal profile were observed in 37 patients (68%) and 15 controls (28%; chi(2) = 16.3; P < 0.0001), and increased L2 vertebra diameters were observed in 34 patients (63%) and none of the controls (chi(2) = 46.7; P < 0.0001). Narrowing and widening of L2-L3 disk space were found in 20 (37%) and seven (13%) patients, respectively. Features of diffuse idiopathic skeletal hyperostosis (DISH) were found in 11 patients (20%) and none of the controls (chi(2) = 10.1; P < 0.001). Disease duration was correlated with vertebral body height (P = 0.001) or intervertebral space height (P = 0.02), and lumbar mobility with thorax expansion (P = 0.004); DISH severity was correlated with basal (P = 0.04) and peak (P = 0.01) glucose levels after glucose load. In conclusion, chronic GH and IGF-I excess typically affects the axial skeleton with development of severe alterations of spine morphology and function until features of DISH occur. An early diagnosis of acromegaly is mandatory to reduce the severity of spine abnormalities as they were significantly higher in patients with longer disease duration.

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.

Diffuse idiopathic skeletal hyperostosis (DISH): is it of vascular aetiology?

OBJECTIVE: Reassessment of the pathological features of spinal involvement in DISH and studying the possible aetiopathogenetic mechanism/s of DISH in view of clinical, radiological and pathological findings. METHODS: Forty Egyptian patients with DISH were included in this study. They underwent clinical and radiological assessment. Routine lab tests were done in addition to measuring blood sugar, serum lipids and uric acid. Pathologic study of 50 macerated specimens of fused spines fulfilling the criteria of DISH was also performed. A pathologic study of another 50 macerated specimens from normal spines were examined as a control. RESULTS: Radiological assessment showed spinal involvement in 100% of the patients in the lower thoracic region, while it was present in 75%, 70% and 55% in the upper thoracic, lumbar and cervical regions respectively. Pathological study revealed a significant increase in the number and width of nutrient foramina, denoting hypervascularity of the ossified ligaments and vertebrae involved (P < 0.001), in addition to a significant (P < 0.001) increase in the size of the affected vertebrae, pointing to the possible role of a vascular disorder in the disease pathogenesis. Metabolic disorders were evident among our group of patients in the form of obesity (50%), hyperlipidemia (80%), diabetes mellitus (60%), and hypertension (45%). CONCLUSION: DISH is a diffuse systemic condition which is most probably related to abnormal bone cell growth/activity reflecting the influence of metabolic factors that lead to new bone deposition. The vertebral blood supply is a predisposing factor that contributes to the onset/progression and/or localization of DISH.

Disfagia causada por osteófito gigante de coluna cervical: relato de caso e revisäo de literatura / Giant cervical osteophyte causing dysphagia: case report and review of the literature

A presença de um osteófito gigante em coluna cervical constitui uma das causas mais raras de disfagia, cuja etiologia mais frequente é a hiperostose idiopática esquelética difusa. Este artigo faz o relato de caso de um paciente com 80 anos de idade portador de um osteófito gigante da coluna cervical na altura de C3-C4, com sintomatologia de disfagia moderada, evoluindo favoravelmente com tratamento clínico medicamentoso associado à fisioterapia