Diffuse idiopathic skeletal hyperotosis

Case contributed by Dr Anthony Nuñez

Presentation

Patient refers back pain and reduced mobility.

Patient Data

Age: 70 years
Gender: Male
X-ray

Spinal X-ray

Ossification of anterior longitudinal ligament is noted from C2 to L5.

Ossification of posterior longitudinal ligament is noted from C2 to C7 level.

Loss of cervical lordosis. 

Nuchal ligament calcification.

Intervertebral spaces are preserved. 

X-ray

Pelvis X-ray

There is cortical 'whiskering' enthesopathy of bilateral ASIS, AIIS, ischial tuberosities, lesser trochanters and iliac crests.

Sacroiliac joints and pubic symphysis are normal.

Ossification of the posterior longitudinal ligament is seen from C2 to D1. 

There is also calcification of the spinous ligament. 

¨Whiskering¨ enteshophytes are better seen at the pelvis. 

Case Discussion

Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier disease is a common condition characterized by bony proliferation at sites of tendinous and ligamentous insertion.

It usually affects the spine with ossification of the anterior longitudinal ligament and pelvis with whiskering calcifications which are symmetrical bone overgrowth at the site of insertion of the pelvic muscles. It generally affects elderly individuals.

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Case information

rID: 68238
Published: 22nd May 2019
Last edited: 24th May 2019
Inclusion in quiz mode: Included
Institution: University Institute CEMIC

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