Diffuse Idiopathic Skeletal Hyperostosis of the Spine: Pathophysiology, Diagnosis, and Management

Hai V. Le, Joseph B. Wick, Benjamin W. Van, Eric O. Klineberg

Research output: Contribution to journalReview articlepeer-review


Diffuse idiopathic skeletal hyperostosis (DISH) is an ankylosing condition affecting up to 32.5% of the general cohort. Although often asymptomatic, affected individuals may present with back pain, stiffness, dysphagia, functional decline, and neurologic deficits. Radiographically, DISH is characterized by flowing ossifications along the anterior spine spanning ≥4 vertebral bodies. Although the etiology of DISH remains unknown, diabetes mellitus and other metabolic derangements are strongly associated with DISH. Importantly, spinal ankylosis in DISH predisposes patients to unstable spine fractures from low-energy trauma, and careful consideration must be taken in managing these patients. This article reviews the epidemiology and pathophysiology of DISH, and its clinical findings, diagnostic criteria, and management.

Original languageEnglish (US)
Pages (from-to)1044-1051
Number of pages8
JournalThe Journal of the American Academy of Orthopaedic Surgeons
Issue number24
StatePublished - Dec 15 2021

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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