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Diffuse Idiopathic Skeletal Hyperostosis M48.10 721.6


synonyms: diffuse idiopathic skeletal hyperostosis, ankylosing hyperostosis, vertebral osteophytosis



  • 721.6 Ankylosing vertebral hyperostosis

DISH Etiology / Epidemiology / Natural History

  • DISH = confluent ossification of at least four continuous vetrebral bodies (3 disc spaces)
  • General white males < 60 years old.

DISH Anatomy

  • Bridging ossification follows the course of the anterior longitudinal ligament

DISH Clinical Evaluation

  • Main complaint is generally stiffness which may be worse in the morning and evening.
  • Mild lumbar and thoracolumbar back pain
  • Decreased spinal ROM.

DISH Xray / Diagnositc Tests

  • A/P and lateral views of the thoracic and lumbar spine demonstrate confluent ossification of at least four continguous vertebral bodies.
  • Cervical spine involvement

DISH Classification / Treatment

  • Aerobic activity / exercise. Activity modifications, NSAIDs.
  • Cervical spine involvement may lead to dysphasia from large osteophytes or myelopathy from ossication of the posterior longitudinal ligament.

DISH Associated Injuries / Differential Diagnosis

DISH Complications

  • Myelopathy
  • Neurogenic claudication
  • Dysphagia
  • Heterotopic ossification (after THA)

DISH Follow-up Care

DISH Review References

  • Belanger TA, JAAOS 2001;9:258