Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next

Mader, Reuven; Verlaan, Jorrit‐Jan; Eshed, Iris; Bruges-Armas, Jácome; Puttini, Piercarlo Sarzi; Atzeni, Fabiola; Buskila, Dan; Reinshtein, Eyal; Novofastovski, Irina; Fawaz, Abdallah; Kurt, de Vlam; Baraliakos, Xenofon

doi:10.1136/rmdopen-2017-000472

Cited by 105 publications

(96 citation statements)

References 62 publications

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“…The vertical presentation we describe is in keeping with previous reports of “flowing” calcifications with bridging angles <45° and >90°, while the horizontal presentation we describe has previously been reported as sharp horizontal outgrowths, resembling osteophytes with bridging angles <90° . Interestingly, the most prominent presentation of large, horizontal outgrowths we detected (58%: n = 44/76 motion segments) resembles what has been described as the “late, advanced, or terminal‐stage” of DISH . The discontinuous‐patchy presentation described in the current study has been noted in previous reports as “unknown floating particles” requiring further characterization .…”

Section: Discussionsupporting

confidence: 92%

“…Of note, the distinct presentations could be detected at individual motion segments within the same vertebral column (all three presentations ¼ 5/10 specimens; two of three presentations ¼ 4/10 specimens; only one presentation ¼ 1/10 specimens), and even within the same motion segment (n ¼ 15/76 motion segments analyzed). If areas of ectopic calcification presenting as large horizontal outgrowths represent sites of more advanced disease, as previously suggested, 22,28,40,41 our findings may suggest an inferior-to-superior disease progression within the thoracic spine. This finding is in contrast to both the superior-to-inferior pattern associated with ossification of the posterior longitudinal ligament (OPLL), 42,43 and to IVD degeneration which primarily affects the lumbar and cervical spine.…”

Section: Discussionsupporting

confidence: 74%

“…24,26,41 Interestingly, the most prominent presentation of large, horizontal outgrowths we detected (58%: n ¼ 44/76 motion segments) resembles what has been described as the "late, advanced, or terminal-stage" of DISH. 22,28,40,41 The discontinuous-patchy presentation described in the current study has been noted in previous reports as "unknown floating particles" requiring further characterization. 28,41 Our analysis also confirmed the characteristic right-sided dominance of ectopic calcifications previously associated with DISH, 46 although differences were evident in localization between presentations, with increased detection of both the vertical and discontinuous-patchy presentations on the left side compared to the horizontal outgrowths.…”

Section: Discussionsupporting

confidence: 72%

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Ectopic spinal calcification associated with diffuse idiopathic skeletal hyperostosis (DISH): A quantitative micro‐ct analysis

Fournier

Norley

Pollmann

et al. 2019

Journal Orthopaedic Research

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Diffuse idiopathic skeletal hyperostosis (DISH) is a non‐inflammatory spondyloarthropathy identified radiographically by calcification of the ligaments and/or entheses along the anterolateral aspect of the vertebral column. The etiology and pathogenesis of calcifications are unknown, and the diagnosis of DISH is currently based on radiographic criteria associated with advanced disease. To characterize the features of calcifications associated with DISH, we used micro‐computed tomographic imaging to evaluate a cohort of 19 human cadaveric vertebral columns. Fifty‐three percent of the cohort (n = 10; 3 females, 7 males, mean age of death = 81 years, range 67–94) met the radiographic criteria for DISH, with calcification of four or more contiguous vertebral segments. In almost all cases, the lower thoracic regions (T8‐12) were affected by calcifications, consisting primarily of large, horizontal outgrowths of bony material. In contrast, calcifications localized to the upper thoracic regions demonstrated variability in their presentation and were categorized as either “continuous vertical bands” or “discontinuous‐patchy” lesions. In addition to the variable morphology of the calcifications, our analysis demonstrated remarkable heterogeneity in the densities of calcifications, ranging from internal components below the density of cortical bone to regions of hyper‐dense material that exceeded cortical bone. These findings establish that the current radiographic criteria for DISH capture heterogeneous presentations of ectopic spine calcification that can be differentiated based on morphology and density. These findings may indicate a naturally heterogenous disease, potential stage(s) in the natural progression of DISH, or distinct pathologies of ectopic calcifications. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 72%

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Ectopic spinal calcification associated with diffuse idiopathic skeletal hyperostosis (DISH): A quantitative micro‐ct analysis

Fournier

Norley

Pollmann

et al. 2019

Journal Orthopaedic Research

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“…The advanced age of the animals in this study may be an important factor in clinical expression, the animals being presented and examined to a late by the veterinarians, which has allowed the emergence and development of associated degenerative processes. In addition, DISH is a predisposing factor in both human (Mader et al, 2017) and dog (Kornmayer et al, 2013) for spinal fractures that can complicate leading to various clinical manifestations as a result of spinal cord injury. Following the ventral longitudinal vertebral ligament ossification, the spine becomes rigid and incapable of absorbing the traction forces acting on it, favouring the occurrence of fractures much easier, even minor trauma (Mader et al, 2017).…”

Section: T11-t12mentioning

confidence: 99%

A Retrospective Radiographic Study Regarding Diffuse Idiopathic Skeletal Hyperostosis (Dish) in Dogs

Tudor

2018

“Agriculture for Life, Life for Agriculture” Conference Proceedings

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Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic non-inflammatory disease of unknown aetiology affecting the axial and appendicular skeleton. The disease is characterised by calcification of soft tissues including tendons, joint capsules, and ligamentous attachments to bone. A retrospective radiographic study was conducted to investigate the presence and distribution of the DISH in dogs. For this goal were revised medical records from the radiology service of Faculty of Veterinary Medicine Bucharest for dogs that had a radiographic report that described the presence of DISH at spine level. The signalments of all dogs were taken from their medical records. From 531 dogs of 19 breeds, 11 dogs (Cross breed = 3; Rottweiler = 3; Boxer = 2; Golden retriever = 2; German shepherd = 1) were diagnosed with DISH, representing 2.07%. Of these, 5 were females and 6 males, aged between 6 and 15 years (an average of 9.81 years). Following the radiographic evaluation, a total of 74 vertebral segments affected by DISH were identified, and the number of vertebral segments affected per dogs varied between 4 and 10. In all cases, the DISH was accompanied by spondylosis deformans. Although the presence of flowing calcification in the ventral aspects of adjacent vertebral bodies is conclusive for classification as DISH, however it is recommended obtaining supplementation data through modern imaging exams on the vertebral structures.

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“…22 Ultimately, our limited understanding of the pathobiology of DISH has resulted in the lack of early diagnostic indicators, prognostic factors, and disease-modifying treatments. 23 The hallmark DISH characteristic of flowing ectopic spinal mineralization is based on radiographic description. 2 The histopathological characteristics of DISH are less well known.…”

Section: Introductionmentioning

confidence: 99%

Dystrophic calcification and heterotopic ossification in fibrocartilaginous tissues of the spine in diffuse idiopathic skeletal hyperostosis (DISH)

et al. 2020

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Diffuse idiopathic skeletal hyperostosis (DISH) is a prevalent noninflammatory spondyloarthropathy characterized by ectopic mineral formation along the anterolateral aspect of the vertebral column, yet little is known about its underlying pathogenesis. Our objective was to evaluate the histopathological features and composition of ectopic mineral within spinal tissues affected by DISH in humans. Thoracic spine segments from six embalmed cadaveric donors (one female and five males; median age 82 years) meeting the radiographic diagnostic criteria for DISH were evaluated using radiological, histological, and physical analyses. Overall, the histological features of ectopic mineralization at individual motion segments were heterogeneous, including regions of heterotopic ossification and dystrophic calcification. Heterotopic ossifications were characterized by woven and lamellar bone, multifocal areas of metaplastic cartilage, and bony bridges along the anterior aspect of the intervertebral disc space. Dystrophic calcifications were characterized by an amorphous appearance, a high content of calcium and phosphorus, an X-ray diffraction pattern matching that of hydroxyapatite, and radiodensities exceeding that of cortical bone. Dystrophic calcifications were found within the anterior longitudinal ligament and annulus fibrosus in motion segments both meeting and not meeting the radiographic criteria for DISH. In summary, our findings indicate that in DISH, ectopic mineral forms along the anterior aspect of the spine by both heterotopic ossification and dystrophic calcification of fibrocartilaginous tissues. Although both types of ectopic mineralization are captured by current radiographic criteria for DISH, dystrophic calcification may reflect a distinct disease process or an early stage in the pathogenesis of DISH.Bone Research (2020) 8:16; https://doi.

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Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next

Cited by 105 publications

References 62 publications

Ectopic spinal calcification associated with diffuse idiopathic skeletal hyperostosis (DISH): A quantitative micro‐ct analysis

Ectopic spinal calcification associated with diffuse idiopathic skeletal hyperostosis (DISH): A quantitative micro‐ct analysis

A Retrospective Radiographic Study Regarding Diffuse Idiopathic Skeletal Hyperostosis (Dish) in Dogs

Dystrophic calcification and heterotopic ossification in fibrocartilaginous tissues of the spine in diffuse idiopathic skeletal hyperostosis (DISH)

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