DISH, Disc Calcification, OPLL

Most common cause of disc calcification

Degenerative changes; occurs in up to 6% of routine abdominal radiographs.

Ochronosis disc calcification pattern

Very dense central nucleus pulposus calcification; begins in lumbar spine and ascends.

CPPD disc calcification pattern

Annulus fibrosus calcification.

Hemochromatosis disc calcification pattern

Annulus fibrosus calcification.

Hypervitaminosis D disc calcification

Annulus fibrosus calcification; uncommon.

Transient disc calcification in children

Cervical spine; spontaneously regresses.

Systemic diseases causing disc calcification

Juvenile idiopathic arthritis, amyloidosis, poliomyelitis, acromegaly, hyperparathyroidism.

Most descriptive term for DISH

Ankylosing Hyperostosis.

Pathology of ankylosing hyperostosis

Enthesopathy with exuberant bone proliferation at ligament/tendon attachments.

Most commonly involved ligament in DISH

Anterior longitudinal ligament (ALL).

Common spinal regions affected by DISH

Mid/lower thoracic, upper lumbar, lower cervical.

Imaging rule for diagnosing DISH

Do not diagnose on AP view alone; confirm with lateral.

Resnick & Niwayama: ligament criterion

Ossification of the ALL over at least 4 contiguous vertebrae.

Resnick & Niwayama: disc space criterion

Early preservation of disc space.

Resnick & Niwayama: facet joint criterion

Early preservation of facet joints.

Resnick & Niwayama: SI joint criterion

No SI erosions, sclerosis, or fusion.

Age group most affected by DISH

Adults over 50; more common in men.

Common symptoms of DISH

Back pain, stiffness; dysphagia if cervical involvement.

Extraspinal involvement in DISH

Shoulders, hips, knees, heels.

Etiology of DISH

Idiopathic; associated with aging, genetics, metabolic factors.

Major complications of DISH

Spinal fractures, dysphagia, breathing issues, metabolic comorbidities.

Relationship between DISH and OPLL

OPLL is separate but commonly coexists with DISH.

Clinical presentation of OPLL

Asymptomatic or radiculopathy/myelopathy; symptoms in 40s–60s.

Most common region for OPLL

Cervical spine (75%).

OPLL epidemiology

More common in men; higher prevalence in East Asians.

OPLL nickname in Japan

“Japanese Disease” — leading cause of cervical myelopathy.

CT appearance of OPLL

Dense ossified mass posterior to vertebral bodies; canal narrowing.

MRI appearance of OPLL

Low signal intensity on all sequences due to ossification.

Chiropractic care for DISH/OPLL

Yes, but HVLA may be contraindicated depending on stability.

Relative contraindications to dynamic thrust

Hypermobility, severe demineralization, benign bone tumors, bleeding disorders, progressive radiculopathy.

Absolute contraindications to dynamic thrust

Acute inflammatory arthropathies (RA, AS), fractures, instability, malignancy, infection, myelopathy/cauda equina, VBI.