DISH & OPLL (DRAFT) Flashcards
what does DISH stand for and what is another name for DISH?
(Diffuse Idiopathic Skeletal Hyperostosis) Forestiere’s disease
what is the etiology of DISH?
unknown
What is DISH? how common is it and what’s the main concept?
- VERY common degenerative condition
- Hypertrophy and Ossification of the ALL
what population does DISH commonly effect?
generally > 50yrs
- 25% of men > 50
- 15% of women > 50
What is the buzz term for DISH?
flowing hyperostosis of the ALL
what is the diagnostic criteria for DISH?
MUST involve 4 or more adjacent segments
what are Enthesophytes?
- bone growth at insertion site of tendon / ligament into bone
(so in DISH: ossification in the middle of the vertebral bodies)
DISH involves extensive ____ formation
enthesophyte
what is an Enthesis?
insertion of tendon / ligament into bone
T/F enthesopathy is a normal age related process.
TRUE, difference between normal age related vs. DISH enthesopathy
up to 50% of DISH pts will have ____
Ossification of the PLL (OPLL)
T/F DISH is more clinically significant that OPLL
FALSE, OPLL is more clinically significant b/c central stenosis
what are the clinical features of DISH?
- 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
what can DISH be associated with? why?
insulin resistance / diabetes mellitus; theory: pituitary disfunction
what are the radiographic features of DISH?
- flowing ossification of ALL generally starts mid-vertebral body extending out
- enthesopathies: nuchal bones, achilles + plantar enthesophytes, pelvic enthesophytes
- cleavage plane
what are nuchal bones?
ossification of nuchal ligament
what areas of the skeleton are most commonly affected by DISH?
lower thoracic MC
- upper lumbar 2nd
- can involve any/all regions of spine
how can we differentiate between DISH and seronegative spondyloarthropathies?
DISH preserves SI jts and facet jts (inflammatory degeneration likes to involve these jts)
what calcification is seen in everyone?
thyroid cartilage calcification (non articular hyaline cartilage)
are nuchal bones normal?
yes, common in older ppl, but increase if have DISH
what is another name for OPLL?
Japanese Spine Disease (NOT only found in Japanese descent)
what is OPLL?
degenerative condition involving hyperostosis of the PLL
what population is OPLL commonly seen in?
> 50yrs
how often do pts w/ DISH co-present w/ OPLL?
0.5
T/F OPLL can be a stand alone condition
t
what is the etiology of OPLL?
idiopathic (like DISH)
what is the diagnostic criteria for OPLL?
DOES NOT have to involve 4 segments
DOES NOT have to have DISH
what areas of the skeleton are most commonly affected by OPLL?
cervical MC; can be any region
what feature of OPLL makes it ^clinically significant
creates central canal stenosis
what are the clinical features of OPLL?
- can be clinically silent
- stiff, achy back/neck pain
- restrict AROM/PROM
- SSx of central canal stenosis
- can lead to myelopathy (myelomalacia)
what is Myelomalacia?
softening of SC (described as “tapioca pudding/cottage cheese consistency”)
what are the radiographic features of OPLL?
- hyperostosis of PLL can be upwards of 5-8mm thick
- parallels posterior VB margin
- DOES NOT have to have DISH
how are DISH and OPLL different in preferntial location?
DISH: lower thoracic MC
OPLL: cervicals MC
