Dissecting Lower Back Pain: Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition characterized by abnormal bone growth along the spine, which can lead to various symptoms, including lower back pain. In this latest and, perhaps, final article of the Dissecting Lower Back Pain series, we will delve into what DISH is and how it can result in low back pain.
What Even is DISH?
DISH, also known as Forestier’s disease, is a non-inflammatory condition where abnormal bone formation occurs along the ligaments and tendons that connect the vertebrae. This leads to the formation of bony outgrowths called osteophytes, primarily affecting the thoracic and lumbar spine.
Image on the left is relatively normal spine x-ray with no evidence of DISH. Image on the right is an x-ray of a patient with DISH, note the wide spread osteophytes between the vertebra.
What Are The Causes of DISH?
The exact cause of DISH is unknown. However, several factors may contribute to its development, including age, genetics, metabolic factors, and mechanical stress on the spine. DISH is more common in older individuals, especially those above 50 years of age, and it is frequently observed in people with metabolic conditions such as diabetes and obesity.
Does Having DISH Result in Lower Back Pain?
Low back pain is a common symptom associated with DISH. The abnormal bone growth in DISH can lead to stiffness, reduced flexibility, and mechanical stress on the spinal joints, causing discomfort and pain in the lower back. The low back pain experienced in DISH is typically chronic in nature and may worsen with physical activity or movements that involve the spine. The pain is often described as a dull ache or stiffness. However, it’s important to note that the severity and location of the pain can vary among individuals with DISH. It’s also worth mentioning that while lower back pain is a common symptom associated with DISH, not all individuals with DISH will necessarily experience significant pain. The presence and intensity of pain can depend on factors such as the extent of spinal involvement, individual pain tolerance, and the presence of other coexisting conditions.
In addition to low back pain, DISH may manifest with other symptoms, including difficulty swallowing (due to osteophytes affecting the esophagus), hoarseness (related to pressure on the vocal cords), and limited range of motion in the spine. Some individuals may also experience symptoms related to the involvement of other joints, such as the shoulders, knees, and hips.
How is DISH Diagnosed?
Diagnosing DISH involves a combination of clinical evaluation, medical history review, and imaging studies. X-rays provide detailed images of the spine and can reveal characteristic findings of DISH, such as ossification of ligaments, bone spurs (osteophytes), and spinal fusion. X-rays can help determine the extent and severity of the condition.
What is the Prognosis for DISH?
The prognosis for individuals with DISH varies depending on the severity of the condition and the presence of associated symptoms. In most cases, the condition progresses slowly and can lead to spinal stiffness and reduced mobility. However, DISH itself is not typically associated with severe complications or disability.
What Are The Treatment Options?
Treatment for DISH primarily focuses on managing symptoms and improving quality of life. This may involve a combination of non-surgical approaches such as physical therapy, pain management strategies, and exercises to improve flexibility and posture. Medications to alleviate pain and inflammation may also be prescribed. In severe cases, surgical intervention may be considered to address complications or correct spinal deformities.
To conclude, Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition characterized by abnormal bone growth along the spine. While DISH can lead to low back pain and other symptoms, it is not typically associated with severe complications. Early diagnosis, appropriate management of symptoms, and lifestyle modifications can help individuals with DISH lead fulfilling lives with minimal discomfort. If you suspect DISH or experience chronic low back pain, it is essential to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan.
