Canis ISSN: 2398-2942

Diffuse idiopathic skeletal hyperostosis (DISH)

Synonym(s): Ankylosing hyperostosis

Contributor(s): Laurent Garosi, , Simon Platt

Introduction

  • Cause: unknown.
  • Signs: often clinically silent, can lead to spinal pain, stiffness and in advanced stages neurological signs.
  • Diagnosis: spinal radiography, advanced imaging of the spine if neurological signs.
  • Treatment: no known cure, analgesic if needed, surgical decompression of neural tissues may provide temporary remission.
  • Prognosis: guarded.

Pathogenesis

Etiology

Pathophysiology

  • Systemic non-inflammatory disorder.
  • Result in calcification and ossification of the soft tissues including the ventral longitudinal ligament and other attachments to bone such as ligaments, tendons and capsules (enthesis).
  • Affects both the axial and appendicular skeleton.
  • DISH in dogs is mostly characterized by generalized new bone formation that appears as flowing ossification due to their trabecular pattern, along the ventral and lateral aspects of the vertebral column.
  • Most commonly in the thoracolumbar vertebral column, especially T6-T10 and L2-L6.
  • Often remain clinically silent but can lead to spinal pain, stiffness and in advanced stages spinal cord or nerve root compression and neurologic deficits.
  • Pain associated with DISH may be due to the involvement of the periosteum and the massive extension of the ossification into the surrounding soft tissues.
  • Bony proliferation in the region of the exit zones of the intervertebral foramen can result in foraminal stenosis and nerve root irritation.
  • An association between intervertebral disk herniation Intervertebral disk: type 1 herniation Intervertebral disk: type 2 herniation at sites adjacent to segments affected with DISH has been suggested but remains to be proven.

Diagnosis

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Treatment

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • De Decker S, Lam R, Packer R M et al (2015) Thoracic and lumbar vertebral bone mineral density changes in a natural occurring dog model of diffuse idiopathic skeletal hyperostosis. PLoS One 10 (4), e0124166 PubMed.
  • Lai A, Culvenor J, Bailey C et al (2015) Femoral nerve entrapment in a dog with diffuse idiopathic skeletal hyperostosis. Vet Comp Orthop Traumatol 28 (2), 151-154 PubMed.
  • Oh J, Lee J H, Cho K O et al (2015) Diffuse idiopathic skeletal hyperostosis with prominent appendicular bone proliferation in a dog. J Vet Med Sci 77 (4), 493-497 PubMed.
  • Togni A, Kranenburg J C, Morgan J P et al (2014) Radiographic and MRI characteristics of lumbar disseminated idiopathic spinal hyperostosis and spondylosis deformans in dogs. J Small Anim Pract 55 , 343-349 PubMed.
  • Wessmann A (2014) Disseminated idiopathic skeletal hyperostosis: diagnostic criteria and clinical significance. Vet Rec 174 (25), 630-631 PubMed.
  • Ciepluch M F, Da Costa R, Russell D (2013) Imaging diagnosis - an atypical presentation of diffuse idiopathic skeletal hyperostosis (DISH) in a dog. Vet Radiol Ultrasound 56 (1), E5-8 PubMed.
  • Ortega M, Goncalves R, Haley A et al (2012) Spondylosis deformans and diffuse idiopathic skeletal hyperostosis (DISH) resulting in adjacent segment disease. Vet Radiol Ultrasound 53 (2), 128-134 PubMed.
  • Greatting H H, Young B D, Pool R R et al (2011) Diffuse idiopathic skeletal hyperostosis (DISH). Vet Radiol Ultrasound 52 (4), 472-473 PubMed.


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