What is the mortality and morbidity associated with diffuse idiopathic skeletal hyperostosis (DISH)?

Updated: Oct 23, 2018
  • Author: Bruce M Rothschild, MD; Chief Editor: Jeffrey D Thomson, MD  more...
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Answer

Diffuse idiopathic skeletal hyperostosis (DISH) appears to be a phenomenon rather than a disease. A double-blind controlled evaluation (in which controls and patients were drawn from the same population) revealed no associated pathology. Arthritis, bursitis, and tendinitis appeared no more frequently in patients with DISH than in controls. Any back pain present was no different in character or duration than that noted in control subjects. A history of back injury was actually found to be twice as frequent in control subjects as it was in patients with DISH. Back flexibility was no more limited in patients with DISH than it was in controls. In fact, patients with DISH who had decreased lumbar spinal motion had a lower frequency of back pain, implying that DISH may be protective. [16, 22] One study has showed that DISH may be protective against back pain. [23]

In another study, people with DISH were more likely to experience physical functional impairment. This included 1.72-fold increased odds of self-reported difficulty bending; worse grip strength; and in men only,  2.17-fold increased odds of being unable to complete 5 chair stands without using their arms. [24]

A study of 1063 patients treated surgically for lumbar spinal stenosis found that reoperations were performed significantly more often in patients with DISH that extended to the lumbar segment: 22% of such patients underwent reoperation, compared with 7.3% of patients without lumbar DISH (P < 0.001). The authors suggest that the unfavorable outcomes in patients with lumbar DISH may be due to the decreased number of lumbar mobile segments. [25]


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