DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH)

Diagnosis

Diagnosing DISH typically involves a combination of clinical evaluation, medical history review, and diagnostic imaging studies. X-rays are the most commonly used imaging modality and can reveal characteristic findings of DISH, including the presence of flowing ossification along the anterior aspect of multiple contiguous vertebral bodies. Additional imaging tests, such as CT or MRI scans will allow doctors to assess the extent of spinal involvement and rule out other potential causes of symptoms.

DISH, or Diffuse Idiopathic Skeletal Hyperostosis, often goes unrecognized and underdiagnosed primarily because many individuals show no symptoms. When symptoms do appear, they’re typically very mild and can sometimes mimic a less serious conditions. According to Dr. Hostin, an orthopedic surgeon at the Southwest Scoliosis and Spine Institite the asymptomatic nature of DISH complicates diagnosis. Therefore, it isn’t until symptoms progress and become more pronounced that DISH is likely diagnosed.

Risk Factors

Enviromental factors can influence DISH, or Diffuse Idiopathic Skeletal Hyperostosis. One of the primary risks involves physical injuries, specifically those related to lifting or moving heavy objects. Individuals with DISH are particularly susceptible to back and spinal injuries that can exacerbate their condition.

Another significant risk is experiencing trips and falls. These events are not only common in everyday life but pose a greater threat to those with compromised spinal health. Such accidents can lead to severe complications and prolonged recovery times for individuals with DISH.

To mitigate these risks, it’s crucial for affected individuals to practice safe lifting techniques, ensure their living and working environments are free from tripping hazards, and seek regular medical advice to manage their condition effectively.

Several other factors may increase the risk of developing DISH, including:

• Advancing age, as DISH primarily affects individuals over 50 years old.
• Male gender, as men are more commonly affected than women.
• Obesity and metabolic syndromeare associated with abnormal glucose metabolism and insulin resistance.
• Certain medical conditions, such as diabetes mellitus, hyperinsulinemia, and hyperlipidemia, may also predispose individuals to DISH.

Can Medication Influence the Development of DISH?

Yes, certain medications may play a role in the development of Diffuse Idiopathic Skeletal Hyperostosis (DISH). For instance, the use of acne medication like isotretinoin has been linked to this condition. Brands such as Amnesteem and Claravis, which contain isotretinoin, are commonly used treatments that might contribute to the onset of DISH. If you’re using these or similar medications and have concerns about potential side effects, it’s crucial to discuss them with your healthcare provider.

Non-Surgical and Surgical Treatment

Treatment for DISH aims to manage symptoms, improve mobility, and prevent complications. Non-surgical approaches may include:

• Physical therapy to improve flexibility, strength, and posture.
• Pain management with over-the-counter or prescription medications.
• Lifestyle modifications, such as maintaining a healthy weight and avoiding activities that exacerbate symptoms.

In cases where conservative measures fail to provide relief or severe complications arise, doctors will recommend surgery. Surgical options may include decompression procedures to alleviate nerve compression or spinal fusion to stabilize the spine and prevent further progression of the disease.

Complications

Complications of DISH may include:

• Spinal stenosis, resulting from the compression of spinal nerves or the spinal cord by bony outgrowths.
• Fractures or dislocations of affected vertebrae due to the increased stiffness and reduced flexibility of the spine.
• Difficulty swallowing or breathing in cases of cervical spine involvement, which may require surgery to alleviate compression of the esophagus or airway.

Physical Therapy Recommendations

Physical therapy plays a crucial role in managing DISH by improving flexibility, strength, and posture. A physical therapist can design a customized exercise program to target specific areas of stiffness or weakness.  In addition, the therapist can teach the patient techniques to improve mobility and reduce pain. Stretching exercises, low-impact aerobic activities, and core strengthening exercises are commonly prescribed to individuals with DISH.

Prevention Actions

While the exact cause of DISH is unknown, several preventive measures may help reduce the risk of developing the condition or alleviate symptoms:

• Maintaining a healthy weight and adopting a balanced diet to reduce the risk of metabolic abnormalities. Weight loss plays a crucial role in preventing Diffuse Idiopathic Skeletal Hyperostosis (DISH). Shedding excess pounds can mitigate the occurrence of conditions that are often linked with DISH, such as diabetes and high blood pressure. By maintaining a healthy weight, you not only reduce the strain on your skeletal system but also improve your overall metabolic health. This preventive approach helps you manage or even avert the development of DISH and its associated complications.
• Engaging in regular physical activity promotes flexibility, strength, and overall musculoskeletal health.
• Practicing good posture and body mechanics to reduce strain on the spine and joints.
• Avoiding tobacco use and excessive alcohol consumption, as these habits may exacerbate inflammation and contribute to bone health issues.

What Can Cause a Serious Fracture With Someone With DISH

Even a minor impact can cause a serious fracture in someone with Diffuse Idiopathic Skeletal Hyperostosis (DISH). This condition leads to the fusion of the spine, which makes it less flexible. As a result, any low-energy trauma or small fall can focus intense force on a specific part of the spine, leading to a significant fracture.

Related Conditions

DISH shares some similarities with other musculoskeletal conditions, such as ankylosing spondylitis and osteoarthritis. However, DISH is characterized by distinct radiographic features, including the presence of flowing ossification along the anterior aspect of vertebral bodies.

Living with the Condition

Living with DISH can present challenges, particularly in managing chronic pain and stiffness. However, with appropriate treatment and lifestyle modifications, many individuals with DISH can maintain an active and fulfilling life. Regular exercise, healthy eating habits, and proper body mechanics can help manage symptoms and improve overall quality of life.

Long-Term Benefits of Treatment

The long-term benefits of treating DISH include:

• Improved mobility and flexibility, allowing individuals to engage in daily activities with greater ease.
• Reduced pain and discomfort, enhancing the overall quality of life and well-being.
• Prevention of complications, such as spinal stenosis or fractures, which can lead to more severe symptoms and functional limitations.

Why Choose the Southwest Scoliosis and Spine Institute

The Southwest Scoliosis and Spine Institute, led by Doctors Richard A. Hostin, Devish Ramnath, and Ishaq Syed, offers comprehensive care for individuals with spinal conditions, including DISH. With offices in Dallas, Plano, and Frisco, Texas, the institute provides state-of-the-art diagnostic and treatment options tailored to each patient’s unique needs. The team of highly experienced spine specialists utilizes advanced techniques and technologies to deliver optimal outcomes and improve patients’ quality of life. From conservative management strategies to advanced surgery, the Southwest Scoliosis and Spine Institute offers compassionate care and personalized treatment plans to help individuals with DISH regain mobility, alleviate pain, and achieve long-term relief.

In conclusion, DISH refers to a non-inflammatory skeletal condition characterized by excessive bone growth along the spine and other parts of the body. While often asymptomatic, DISH can lead to pain, stiffness, and mobility issues in some cases. Treatment options include non-surgical approaches such as physical therapy and pain management, as well as surgery for severe cases. Choosing a specialized spine institute like the Southwest Scoliosis and Spine Institute can provide individuals with access to comprehensive care and advanced treatment options to effectively manage DISH and improve their quality of life.

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Arthritis Foundation: Diffuse Idiopathic Skeletal Hyperostosis