Diffuse Idiopathic Skeletal Hyperostosis (DISH) and the Key Differences from Ankylosing Spondylitis скачать в хорошем качестве

Diffuse Idiopathic Skeletal Hyperostosis (DISH) and the Key Differences from Ankylosing Spondylitis

Join this channel to support this channel    / @nabilebraheim   DISH (Diffuse Idiopathic Skeletal Hyperostosis) DISH is characterized by flowing ossification along the anterolateral aspect of at least four consecutive vertebrae. On X-ray, you will observe ossification along the anterior body of the vertebrae, which remains separate from the vertebrae themselves. The disc height is preserved. This condition typically affects older individuals (50 years and above). It can involve the entire spine but is more commonly seen in the thoracic region, especially on the right side, which is a hallmark feature of DISH. In the lumbar and cervical vertebrae, the syndesmophytes are symmetrical on both the right and left sides. Unlike other conditions, DISH does not involve the intervertebral discs, facet joints, or sacroiliac joints. Patients often have comorbidities such as gout, diabetes, or high cholesterol, so it is important to test hemoglobin A1c in these patients. Patients with DISH commonly present with back pain and spinal stiffness. The condition produces large syndesmophytes, and when it occurs in the cervical spine, it can lead to symptoms such as dysphagia, hoarseness, and sleep apnea. The diagnosis of DISH is confirmed by spinal X-ray, where anterior bony fragments are visible, and the intervertebral discs remain preserved. Spinal fractures in DISH, often resulting from hyperextension injuries, can be occult and caused by minor trauma, leading to significant instability. These fractures carry a high mortality rate, especially when treated non-operatively. If a patient reports sudden neck or back pain, even minimal, and X-rays appear normal, obtain a CT scan or MRI to rule out occult fractures. Additionally, patients with DISH are at increased risk for heterotopic ossification following total hip arthroplasty. Comparison Between DISH and Ankylosing Spondylitis DISH: Flowing large syndesmophytes. No bamboo spine. Sacroiliac (SI) joints are not involved. Occurs in older patients. Some patients may have diabetes; hemoglobin A1c testing is recommended. Ankylosing Spondylitis: quizzes Quiz 1: What is a characteristic feature of DISH on spinal X-ray? A. Ossification along the posterior vertebrae B. Flowing ossification along the anterolateral vertebrae C. Narrowing of the intervertebral discs D. Fusion of the sacroiliac joints Correct Answer: B Explanation: In DISH, flowing ossification is observed along the anterolateral aspect of at least four continuous vertebrae while disc height is preserved. Quiz 2: Which symptom is more likely associated with cervical spine involvement in DISH? A. Limited chest expansion B. HLA-B27 positivity C. Dysphagia and hoarseness D. Sacroiliac joint fusion Correct Answer: C Explanation: When DISH affects the cervical spine, it can cause symptoms like dysphagia, hoarseness, and sometimes sleep apnea due to compression or impingement. Quiz 3: Which condition is NOT associated with DISH? A. Diabetes mellitus B. High cholesterol C. Sacroiliac joint fusion D. Facet joint fusion Correct Answer: D Explanation: DISH does not involve the discs, facet joints, or sacroiliac joints, distinguishing it from other conditions like ankylosing spondylitis. Quiz 4: What is a hallmark feature of ankylosing spondylitis on imaging? A. Large osteophytes B. Bamboo spine appearance C. Unilateral sacroiliac joint involvement D. Preserved disc spaces Correct Answer: B Explanation: In ankylosing spondylitis, the bamboo spine appearance is due to the ossification of intervertebral discs and fusion of vertebrae.