The Diffuse Idiopathic Skeletal Hyperostosis (DISH): A Literature Review on the Rehabilitation Treatment

Abstract

Introduction. The diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier-Rotès-Querol disease, is a systemic pathology characterized by the diffuse ossification of the ligaments of the spinal column. It can be linked to several metabolic disorders, such as obesity and type II diabetes, and its prevalence among the elderly population is high. DISH may be asymptomatic and only acknowledged in the imaging, or it can be associated to serious clinical conditions like stiffness, pain and reduced spine mobility. At the moment, specific guidelines for the treatment of the DISH do not exist. This article aims to analyze the available literature concerning the rehabilitation treatment in patients affected by DISH. Materials and methods. Until July 2023, PubMed, PEDro, Scopus and Google Scholar were accessed, with no time constraints. Results. The literature available is poor, but the authors of the selected studies suggest programs based on therapeutic exercise, manual therapy, postural education, instrumental physical therapy. The discrepancy between the results obtained in case report and in RCT and cohort study, may express the need of a personalized treatment, since the characteristic of the pathology are variable depending on the localization of the hyperostosis. The rehabilitation strategies just proposed may be investigated in order to create a therapeutic path for DISH patients. Conclusions. Patients affected by DISH may cope with conditions of severe disability, caused by stiffness, pain, respiratory and dysphagic symptoms. The physiotherapy program should be based on stretching and mobility exercises to avoid pain and stiffness. This can be seen as the starting point, so that in the future this pathology might be more researched and easily diagnosed, in order to create useful guidelines and to better manage this less-known clinical condition.