Lecture 8: DISH Flashcards
What is the most common area for DISH in the Cx
C4-C7
What is the most common area for DISH in the Lx? Describe
L1-L3
Hyperostosis starts in mid and upper anterior body, tapering upwards (candle flame)
Similar to Cx appearance, discal extrusion clefts
May displace aortas
Describe DISH in the extra spinal areas
- Any lig or tendon insertion can calcify/ossify
- Most common sites in the pelvis, patella, calcaneus, foot or elbow
- About 30% of cases show extra spinal involvement
- ‘Whiskering’ at insertion points; ligaments/tendon ossification
- Adjacent joint spaces remain normal
Who gets DISH
Uncommon before 50yoa
>50 = 25% males and 15% females
>80yoa = 28% males and 26% females
How would you describe this?
Flowing hyperostosis
Preservation of disc spaces
Undulating contour ossifications
Radiological features of DISH
Flowing calcification/ossification of anterior portions of at least 4 continuous segments
Preservation of IVD height, lack of disc generation
No ankylosis of facets
No degeneration of SIJs (absence of joint erosion, sclerosis and osseous fusion)
Clinical features of DISH
- Often asymptomatic
- 20-50% have diabetes
- Morning stiffness and pain
- Most common spinal sites: thoracolumbar first, the Cx then Lx
- Extra spinal sites = pelvis, knee, foot, elbow
- Apophyseal joints spared; spinal motion may be maintained
What is the most common area for DISH in the Tx? Describe this involvement in the Tx spine
T7-T11
Usually right sided involvement (left sided is spared as the pumping motion of the aorta stops calcification underneath it
Ossifications can be 2cm thick
Apophyseal joints not affected
What is DISH
Diffuse idiopathic skeletal hyperostosis
- pretty much the ossification of ligaments in the spine
- A common disorder of unknown aetiology characterised by back pain and stiffness
- Has ossifying diathesis; predisposition to form bone in ligamentous and tendinous attachments
- Non inflammatory
- Anterior longitudinal ligament calcification and eventual ossification
- Distal extensions may prevent ossification at disc levels
How do we describe the calcification /ossification in DISH?
- ‘dripped candle wax’
- ‘flame shaped osteophytes’
- ‘flowing hyperostosis’
- ‘undulating (bumpy) contour ossification
Describe DISH in the SIJ
- Later development (spine is usually earlier)
- Bilateral
- Ossification may occur in superior and inferior ligaments
- Synovium joints remain unaffected
How would describe this image
DISH
‘dripped candle wax’ appearance
