Diffuse Idiopathic Skeletal Hyperostosis (DISH) – Back Pain Really Does Hurt


Spine Community News: Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition that causes calcifications of ligaments that surround the spine resulting in lower back stiffness. These large, bony outcroppings look like the syndesmophytes associated with ankylosing spondylitis (AS) but are entirely different. For example, stiffness not pain has been considered to be the hallmark of DISH while AS is associated with significant back pain. A recent study presented at the American College of Rheumatology 2017 Annual meeting suggests that many patients with DISH also experience significant pain.

Classic DISH is described as a radiographic illness associated with flowing anterior osteophytes noted over 4 vertebral spaces, most commonly found in the thoracic spine. Doctors from the Oregon Health and Science University reviewed the records of 3439 individuals diagnosed with DISH over a 10 year period. In 2015, 196 patients with DISH were diagnosed and of these 153 fulfilled DISH diagnostic criteria and 41 were close to fulfilling criteria. Of interest, 63% of classic DISH and 81% of almost DISH patients complained of back pain. The most common location was the thoracic spine in 70 % of patients. Overall painful 54% of these individuals used opioids for pain relief and spinal surgery was completed on about 32% of patients.

The report suggests that DISH is more than an asymptomatic radiographic illness. Back pain is more common in DISH than previously reported and in face is a painful illness in a majority of patients who experience the disease. Moreover surgical intervention appears to be necessary in up to 1/3 of individuals.

David Borenstein, MD
Executive Editor TheSpineCommunity.com


Tripathi M et al. Frequency, Morbidity and Healthcare Utilization of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Patients at a University Hospital [abstract] Arthritis Rheumatol 2017;69 (suppl 10).


Understanding Back Pain