In his latest installment to the Total Spine series of instructional videos, Dr. Paul McCormick describes retropleural thoracotomy, a surgical technique used to treat complex spinal conditions of the thoracic and lumbar spine. “Retropleural thoracotomy is an important...
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Diffuse = spread out, not confined to a single location
Diffuse idiopathic skeletal hyperostosis (DISH) is a form of arthritis that involves the tendons and ligaments around the spine. Also known as Forestier’s disease, this condition occurs when these tendons and ligaments become hardened, a process known as calcification. Once the tendons and ligaments harden, parts of these tissues can turn into bone. This usually occurs where the tissue connects with the bone. As a result, bone spurs develop, which is an outgrowth of bone that develop along the edges of a bone.
DISH commonly affects the upper part of the back and neck, known as the thoracic and cervical spine. However, DISH can also affect the shoulders, elbows, hands, knees, hips, heels, and/or ankles.
DISH may or may not cause symptoms.
If DISH causes symptoms, these may include:
Symptoms usually develop when the bone spurs begin to compress the nearby nerves of the spine.
|Causes and Risk Factors|
Although the cause of DISH is unknown, there are certain risk factors that are thought to increase the risk for DISH. These include:
|Tests and Diagnosis|
If a patient presents with symptoms associated with DISH, the doctor may perform a physical examination of the spine. The doctor can often make a diagnosis based on signs and symptoms.
To confirm a diagnosis of DISH, an X-ray is often performed, which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
To rule out other conditions, the doctor may order the following diagnostic procedures:
Usually, treatment involves anti-inflammatory drugs, including non-steroid anti-inflammatory drugs (NSAIDS). Treatment will also typically include physical therapy to help reduce stiffness.
Since there is a connection between endocrine disorders such as diabetes mellitus and DISH, addressing the underlying condition can help stop the progression of DISH.
In some cases, surgery may be needed to correct structural problems in the spine. Surgery may also be an option for those patients who have difficulty swallowing as a result of bone spurs in the neck.
If DISH has resulted in bone spurs in and around the spine, and if these bony growths begin to compress the spinal cord and/or nerve roots, surgery to decompress the spinal cord may be required. In addition, if DISH has resulted in fractures, surgery is required to repair the fracture. If these fractures begin to compress the spinal cord and/or nerve roots, surgery to decompress the spinal cord may be necessary.
The surgeon may elect to perform any of the following surgical procedures to remove the pressure on the spinal cord and/or nerve roots:
In some cases, the surgeon may perform a spinal fusion to ensure the spinal column is stable after surgery. During a spinal fusion, the surgeon may place a bone in the open space and allow the bones to fuse together (fusion).
The surgeon will tailor treatment to each patient and each situation.
|Preparing for Your Appointment|
If you decide to have surgical treatment, Drs. Paul C. McCormick, Michael G. Kaiser, Alfred T. Ogden, Christopher E. Mandigo and Dr. Patrick C. Reid at The Spine Hospital at The Neurological Institute of New York are experts in expert in treating diffuse idiopathic skeletal hyperostosis (DISH). They can also offer you a second opinion.
Helpful Surgery Overviews
Dr. McCormick will choose the treatment method specific to each patient and situation. Some of the condition’s treatment options may be listed below.
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