Presentation
Neck pain and stiffness with dysphagia.
Patient Data
Flowing ossification four contiguous vertebrae seen in the cervical spine. No ankylosis of the sacroiliac joints.
Case Discussion
Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory spondyloarthropathy. The radiological imaging findings are characteristic, although have to be differentiated from other spondyloarthropathies.
Florid flowing ossifications involving four or more contiguous vertebrae on anterior aspects, preservation of the disc spaces and the facet joints helps to identify the disease radiologically. Classically, advanced disease may have "melted candle wax" appearance along the spine on radiographic studies.
Extra-spinal features include enthesopathy at various sites (iliac crest, ischial tuberosities, and greater trochanters).
Differential diagnosis:
- ankylosing spondylitis
- degenerative disease
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