DI 1 DISH and Disc Calcifications

DISH definition

Diffuse idiopathic skeletal hyperostosis characterized by ligament ossification

Other name for DISH

Forestier disease

Primary structure affected in DISH

Anterior longitudinal ligament

DISH hallmark finding

Flowing ossification over at least 4 contiguous vertebrae

Resnick criteria for DISH

Ossification of ALL over 4 vertebrae, preserved disc space, preserved facet joints, no SI joint involvement

Disc space in DISH

Preserved (early)

Facet joints in DISH

Preserved (early)

SI joint involvement in DISH

Absent

Most common spinal region in DISH

Thoracic spine

Age group for DISH

Over 50

Sex predominance in DISH

Males greater than females

Pathophysiology of DISH

Enthesopathy with excessive bone formation at ligament attachments

Common symptoms of DISH

Back stiffness and pain or asymptomatic

Serious complication of cervical DISH

Dysphagia or breathing difficulty

Etiology of DISH

Idiopathic (unknown cause)

Radiographic requirement for diagnosing DISH

Lateral view confirmation

Key difference between DISH and ankylosing spondylitis

SI joints are normal in DISH

Disc calcification most common cause

Degenerative

Annulus fibrosus calcification associated with

CPPD and metabolic diseases

Nucleus pulposus calcification associated with

Ochronosis

Ochronosis radiographic feature

Dense central disc calcification with osteopenia

Disc calcification in children

Usually cervical and self-resolving

Other causes of disc calcification

Trauma, hemochromatosis, hyperparathyroidism, amyloidosis

Management of degenerative disc calcification

Same as osteoarthrosis management

OPLL definition

Ossification of the posterior longitudinal ligament

OPLL symptoms

Radiculopathy and myelopathy

Most common region for OPLL

Cervical spine

OPLL association

DISH

OPLL epidemiology

More common in older males and East Asian populations

Major complication of OPLL

Spinal cord compression

Enthesis definition

Attachment site of tendon or ligament to bone

Enthesopathy definition

Pathology at tendon or ligament attachment

Key radiographic clue for DISH

Flowing anterior ossification with preserved disc spaces

Why AP view is insufficient for DISH

Does not adequately show anterior longitudinal ligament ossification