DISH & OPLL (DRAFT)

Question 1

what does DISH stand for and what is another name for DISH?

Answer 1

(Diffuse Idiopathic Skeletal Hyperostosis) Forestiere’s disease

Question 2

what is the etiology of DISH?

Answer 2

unknown

Question 3

What is DISH? how common is it and what’s the main concept?

Answer 3

• VERY common degenerative condition
• Hypertrophy and Ossification of the ALL

Question 4

what population does DISH commonly effect?

Answer 4

generally > 50yrs
- 25% of men > 50
- 15% of women > 50

Question 5

What is the buzz term for DISH?

Answer 5

flowing hyperostosis of the ALL

Question 6

what is the diagnostic criteria for DISH?

Answer 6

MUST involve 4 or more adjacent segments

Question 7

what are Enthesophytes?

Answer 7

• bone growth at insertion site of tendon / ligament into bone
  (so in DISH: ossification in the middle of the vertebral bodies)

Question 8

DISH involves extensive ____ formation

Answer 8

enthesophyte

Question 9

what is an Enthesis?

Answer 9

insertion of tendon / ligament into bone

Question 10

T/F enthesopathy is a normal age related process.

Answer 10

TRUE, difference between normal age related vs. DISH enthesopathy

Question 11

up to 50% of DISH pts will have ____

Answer 11

Ossification of the PLL (OPLL)

Question 12

T/F DISH is more clinically significant that OPLL

Answer 12

FALSE, OPLL is more clinically significant b/c central stenosis

Question 13

what are the clinical features of DISH?

Answer 13

• can be clinically silent
• stiff, achy back/neck pain
• association w/ insulin resistance / diabetes mellitus; theory: pituitary disfunction
• restrict AROM/PROM; from full to ankylosis
• spinal patho Fx (risk^ due to ankylosis)
• ^thoracic kyphosis

Question 14

what can DISH be associated with? why?

Answer 14

insulin resistance / diabetes mellitus; theory: pituitary disfunction

Question 15

what are the radiographic features of DISH?

Answer 15

• flowing ossification of ALL generally starts mid-vertebral body extending out
• enthesopathies: nuchal bones, achilles + plantar enthesophytes, pelvic enthesophytes
• cleavage plane

Question 16

what are nuchal bones?

Answer 16

ossification of nuchal ligament

Question 17

what areas of the skeleton are most commonly affected by DISH?

Answer 17

lower thoracic MC
- upper lumbar 2nd
- can involve any/all regions of spine

Question 18

how can we differentiate between DISH and seronegative spondyloarthropathies?

Answer 18

DISH preserves SI jts and facet jts (inflammatory degeneration likes to involve these jts)

Question 19

what calcification is seen in everyone?

Answer 19

thyroid cartilage calcification (non articular hyaline cartilage)

Question 20

are nuchal bones normal?

Answer 20

yes, common in older ppl, but increase if have DISH

Question 21

what is another name for OPLL?

Answer 21

Japanese Spine Disease (NOT only found in Japanese descent)

Question 22

what is OPLL?

Answer 22

degenerative condition involving hyperostosis of the PLL

Question 23

what population is OPLL commonly seen in?

Answer 23

> 50yrs

Question 24

how often do pts w/ DISH co-present w/ OPLL?

Answer 24

0.5

Question 25

T/F OPLL can be a stand alone condition

Answer 25

t

Question 26

what is the etiology of OPLL?

Answer 26

idiopathic (like DISH)

Question 27

what is the diagnostic criteria for OPLL?

Answer 27

DOES NOT have to involve 4 segments
DOES NOT have to have DISH

Question 28

what areas of the skeleton are most commonly affected by OPLL?

Answer 28

cervical MC; can be any region

Question 29

what feature of OPLL makes it ^clinically significant

Answer 29

creates central canal stenosis

Question 30

what are the clinical features of OPLL?

Answer 30

• can be clinically silent
• stiff, achy back/neck pain
• restrict AROM/PROM
• SSx of central canal stenosis
• can lead to myelopathy (myelomalacia)

Question 31

what is Myelomalacia?

Answer 31

softening of SC (described as “tapioca pudding/cottage cheese consistency”)

Question 32

what are the radiographic features of OPLL?

Answer 32

• hyperostosis of PLL can be upwards of 5-8mm thick
• parallels posterior VB margin
• DOES NOT have to have DISH

Question 33

how are DISH and OPLL different in preferntial location?

Answer 33

DISH: lower thoracic MC
OPLL: cervicals MC