Diffuse idiopathic skeletal hyperostosis

Case contributed by Dr Fatmah M. Al Zeyoudi


This man presented with neck and shoulder pain, more on the left side.

Patient Data

Age: 60 years
Gender: Male

Lateral radiograph of the cervical spine shows exuberant ossification of the anterior longitudinal ligament and flowing bridging anterior osteophytosis.

The intervertebral disc spaces are preserved. The vertebral bodies heights are preserved.

No fracture or dislocation.

Case Discussion

Key points to differentiate diffuse idiopathic skeletal hyperostosis (DISH) from ankylosing spondylitis (AS) or ossification of the posterior longitudinal ligament (OPLL):

  1. Dense ossification of anterior longitudinal ligament with or without osteophytes (versus fine calcification of the annulus fibrosis in AS).
  2. At least four contiguous vertebral bodies involved.
  3. Intervertebral disc spaces maintained.
  4. Ossification of the superior portion of sacroiliac joints, pelvic ligaments and posterior longitudinal ligament (versus posterior longitudinal ligament ossification with bulky anterior osteophyte formation in OPLL).

Special thanks to Dr Tamer Elholiby.

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Case information

rID: 50953
Published: 7th Feb 2017
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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