Pediatric Orthopedic Surgeons treating Diffuse Idiopathic Skeletal Hyperostosis



Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a kind of arthritis that primarily impacts the spine. Because of bony growths that form along the spine or other damaged bones, doctors are able to diagnose the DISH condition.

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Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) is a kind of arthritis that primarily impacts the spine. Because of bony growths that form along the spine or other damaged bones, doctors are able to diagnose the DISH condition. On X-rays, bone spurs — these growths — are easily seen. Furthermore, this condition is not associated with inflammation like other kinds of arthritis. For example, it entails the hardening (calcification) of ligaments and connective tissues, most commonly in the spine, resulting in “bony bridges” connecting the tiny bones of the back (called vertebrae).

This hardening of ligaments and connective tissue may also be seen in the tissues surrounding the body’s other joints, such as the knees, elbows, and Achilles tendons.  Where the tendons and ligaments join to the bone, this condition causes bony growths. DISH is not a new disease. It is confirmed throughout the archaeological record and has even been found in ancient Egyptian sites. However, many doctors are still unfamiliar with DISH because the symptoms differ from person to person, and the lack of understanding of the disease.

How Common is DISH? 

Doctors consider DISH as the second most common form of arthritis after osteoarthritis. The exact prevalence and incidence of DISH are unknown as it is often undetected in the early stages of the disease. About 15-25% of North Americans over the age of 50 have DISH. The prevalence of DISH increases with each decade as the condition becomes better know and there are better tools to discover it.  Interesting is the fact that it is diagnosed twice as often in men as in women.

Diffuse Idiopathic Skeletal Hyperostosis Warning Indicators 

In the very early stages of the disease, many persons with DISH exhibit either minor symptoms or none at all. Initial DISH symptoms differ from person to person. It’s common to attribute “normal aging” to the minor symptoms that early DISH patients experience. In general, DISH patients frequently have more back stiffness and discomfort than the overall population. In the morning or after extended periods of inactivity, DISH symptoms include persistent or recurrent back discomfort and restricted range of motion. Mild exercise often helps to reduce the stiffness and back discomfort caused by DISH. As DISH worsens, the size and placement of the bony growths start to impact the surrounding tissues. However, this does not always happen.

DISH patients may have trouble swallowing due to esophageal tightness. Obstruction of the upper airway (more so in the pharynx and larynx than in the trachea) can result in aspiration (inhaling saliva into the lungs by accident), hoarseness, stridor, and sleep apnea (a sleep disorder in which breathing stops repeatedly during sleep). A higher risk of vertebral fractures may also exist in DISH patients. Due to the bony growths impacting those tendons and ligaments, individuals with DISH may also have recurrent episodes of discomfort in the area of joints in the arms and legs that feels like tendonitis. The pressure of bony growths on the spinal nerves can cause abnormal feelings in the arms or legs, as well as loss of muscular power. Despite being uncommon, a doctor should still evaluate the symptoms and check for bony growths vis an X-ray.

Diagnosing the DISH Condition

An X-ray serves as the main diagnostic tool for the DISH condition. On an X-ray, the bone growths brought on by DISH are typically easily seen to support the diagnosis. In fact, an X-ray is frequently the sole diagnostic tool required because many DISH patients exhibit no symptoms at first. If a patient has discomfort or want a closer look at the growths, your doctor may occasionally request further imaging tests to confirm the condition and to search for other disorders that might also cause discomfort and pain. Your doctor may request a CT or MRI scan to get a better view. These examinations can reveal inflammation, deterioration, fractures, or further pain-related conditions.

Diffuse Idiopathic Skeletal Hyperostosis Risk Factors

What may raise the risk of the illness is something that doctors are aware of and consist of the following:

  • Sex. DISH is more prevalent in men.
  • Older age. DISH is more prevalent among the elderly, particularly those over 50.
  • Diabetes and other conditions. DISH appears more common in people with type 2 diabetes than in people without the disease. 
  • Certain medications. Long-term usage of retinoids, which include isotretinoin (Amnesteem, Claravis, among others), a drug used to treat skin disorders including acne, can raise the risk.


DISH patients run the risk of developing issues like:

  • Disability. Patients may not use an afflicted joint if there is a loss of range of motion. DISH, for instance, might make it challenging to use an arm.
  • Difficulty swallowing. Osteophytes in the neck can put pressure on the esophagus. Pressure from bone spurs can also cause hoarseness and sleep apnea. Rarely, does this become severe and require surgery to remove the osteophytes.
  • Spinal fracture. Osteophytes in the neck can put pressure on the esophagus. Pressure from bone spurs can also cause hoarseness and sleep apnea. Rarely, does this become severe and require surgery to remove the osteophytes.

Diffuse Idiopathic Skeletal Hyperostosis Treatment

In order to relieve stiffness, treatments typically include medication and physical therapy. Non surgical treatments are available and they are effective and capable of significantly reducing symptoms. The spinal cord and/or nerve roots may need an operation if DISH has compressed them. Our doctors at this point will develop a strategy for each persons individual condition.  

Non-surgical Treatments

Our doctor will work to reduce inflammation in an effort to stop any more calcification from happening. Ibuprofen (Advil, Motrin), naproxen (Aleve), and other non-steroid anti-inflammatory drugs can treat pain and lessen inflammation brought on by DISH. Additionally, treating the underlying illness can help limit the growth of DISH because of the link between DISH and endocrine disorders like diabetes. Physical therapy will help to alleviate stiffness once the inflammation has been brought under control.

Surgical procedures/treatments

Doctors may recommend Surgery if:

  1. The spinal cord or nerve roots start to swell under the weight of bone spurs.
  2. The DISH caused fractures that compressed the spinal cord or nerve roots causing pain.
  3. DISH caused structural problems in the spine.

Resolving issues with the following solutions:

  1. A surgery that removes a portion of the lamina, which is the bony ceiling of the spinal canal, to provide more room.
  2. A treatment to alleviate aberrant pressure on the spinal cord by allowing the spinal cord and nerve roots more room.
  3. A procedure where the entire or a portion of the vertebral body is removed, often to relieve pressure on the spinal cord and nerves
  4. A treatment that involves the removal of aberrant disc material pressing against the spinal cord or a nerve root.
  5. Spinal fusion. an operation to fuse two or more vertebrae together to strengthen the spine.


The stiffness brought on by DISH can be loosened up with physical therapy. Your child’s joints’ range of motion could improve with exercise. Ask your doctor about the exact workouts that are right for your child to perform. For more assistance, your doctor could suggest that you speak with a physical therapist.

Lifestyle and Home Remedies for Diffuse Idiopathic Skeletal Hyperostosis

Try these self-care techniques to assist in managing the pain and stiffness and slow the disease’s progression:

  • Exercise regularly. Regular cardiovascular activity, such as walking or swimming, can boost your child’s endurance, make the body more agile, and help your child deal with DISH. Before beginning a workout schedule, consult with your doctor or surgeon.
  • Achieve and maintain a desirable weight. Obesity is associated with DISH, so losing weight can help prevent disease progression and reduce the risk of complications.
  • Apply heat. Use a heating pad on the affected area of ​​the body to relieve pain. Set the heating pad at low to reduce the risk of burns.

Diffuse Idiopathic Skeletal Hyperostosis Prevention

DISH can actually become quite common with age, but experts agree that most experience few, if any, symptoms. Weight loss is an important preventive measure, especially as it can combat (and even prevent) problems that appear to be associated with DISH, such as diabetes and high blood pressure. Avoiding injury in patients with extensive DISH and an ankylosing (fused) spine is as easy as being careful not to fall. And watch out for back sprains and strains at all times. Use the right lifting and dragging techniques, especially for large things. Start your child’s workouts gently and with the correct safety measures (like yoga mats and the right sneakers).

Medical City Children’s Orthopedics and Spine Specialists

The Doctors at Medical City Children’s Orthopedics and Spine Specialists treat DISH patients with a number of objectives in mind. The initial step is to relieve the patient’s pain and/or any discomfort. Helping them maintain their range of motion and making an effort to regain any lost mobility is the second objective. The final objective is to stop the illness from getting worse. Medical City Children’s Orthopedics and Spine Specialists provides the best up to date medical care possible.

For providing cutting-edge pediatric orthopedic care, Medical City Children’s Orthopedics and Spine Specialists has received recognition. Families come from all over the world to consult with our skeletal dysplasia specialists. Even the most uncommon skeletal dysplasia, such as Diffuse Idiopathic Skeletal Hyperostosis, may be diagnosed through our genetics specialists thanks to their expertise. After determining your child’s health, our care teams collaborate to develop a specialized treatment strategy that is tailored to your child’s requirements.

Finally, our renown pediatric orthopedic specialists will provide world class treatments to children with DISH.   Skeletal dysplasia may vary and evolve over time, and thus, Medical City Children’s Orthopedics and Spine Specialists has developed one of the best pediatric imaging systems in the world to monitor and record changes in children’s bodies.

Call 214-556-0590 to make an appointment.

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