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  1. Symptoms and diagnosis
  2. DISH versus ankylosing spondylitis
  3. Swallowing and airway problems
  4. Treatment and surgery
  5. Fractures and neurological complications
  6. Living with DISH and follow-up
  7. Research and evidence
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Diffuse idiopathic skeletal hyperostosis (DISH), also called Forestier disease, is a condition in which bone forms where ligaments and tendons attach to bone. It mainly affects the spine, where flowing bone grows down the front and sides of the vertebrae and gradually bridges them together, most often in the chest (thoracic) spine. It can also affect tendon attachments elsewhere in the body. "Idiopathic" means the cause isn't known1.

Who gets DISH

DISH is most common in older adults and in men, and it is associated with obesity, type 2 diabetes and other metabolic conditions. These are associations; they don't show that controlling them reverses DISH1.

Symptoms

Many people with DISH have no symptoms, and the condition is found on an X-ray or scan done for another reason. Others have stiffness, back or neck pain, and reduced movement of the spine2. The amount of bone on a scan doesn't predict how much a person is affected.

Large bony spurs (osteophytes) can press on nearby structures and cause specific problems:

  • In the neck, spurs on the front of the spine can press on the throat and food pipe, causing difficulty swallowing, hoarseness and, rarely, breathing problems3.
  • In the chest, spurs lie close to the sympathetic nerves; whether they cause symptoms by pressing on them has been studied very little4.

Being unable to swallow saliva, or difficulty breathing, needs emergency care5.

Fractures

A spine fused by DISH is rigid, like a long bone, and can break after minor falls. These fractures can be unstable and hard to see on plain X-rays, and the diagnosis is sometimes delayed, which can lead to damage to the spinal cord67. Anyone with DISH who has new neck or back pain after a fall or injury should be assessed promptly and tell the team that they have DISH. See fractures and neurological complications.

Diagnosis

DISH is diagnosed on imaging. The classic criteria require flowing bone across at least four consecutive vertebrae, with the discs and the small joints at the back of the spine preserved. Newer criteria based on CT aim to recognize earlier bridging8. DISH is distinguished from ankylosing spondylitis, which affects younger people and the sacroiliac joints. See symptoms and diagnosis and DISH vs ankylosing spondylitis.

Treatment

There is no treatment that removes the extra bone throughout the body or stops it forming1. Treatment aims at symptoms and complications:

  • Physical therapy and pain medicines for stiffness and pain.
  • Surgery to remove neck osteophytes when they cause swallowing problems. In a series of 21 patients, 16 had improved one month after surgery3.
  • Removal of thoracic osteophytes when they are thought to compress nerves.
  • Stabilization surgery for unstable fractures6.

See treatment and surgery and living with DISH.

About the editor

Dr. Kamran Aghayev

Neurosurgeon, Associate Professor of Neurosurgery · Istanbul

Dr. Kamran Aghayev is a neurosurgeon in Istanbul and an associate professor of neurosurgery, with more than 20 years in practice. He trained in neurosurgery at Hacettepe University in Ankara, completed spinal oncology and neuro-oncology fellowships at the H. Lee Moffitt Cancer Center in Tampa, Florida, and taught there as a clinical instructor before returning to Turkey. He chaired the neurosurgery department at Biruni University in Istanbul from 2017 to 2020. His published work includes a surgical technique for jugular vein decompression in atlanto-styloid compression and the PURED operation for thoracic outlet syndrome, and he is a named inventor on 13 U.S. patents for spinal devices.

How this site is editedkamranaghayev.com

References

  1. Mader R et al. RMD Open. 2017;3:e000472. doi:10.1136/rmdopen-2017-000472. Source ↩
  2. Cleveland Clinic. Diffuse Idiopathic Skeletal Hyperostosis. Updated 28 April 2024. Source ↩
  3. Chung YS et al. Yonsei Medical Journal. 2020;61:341–348. doi:10.3349/ymj.2020.61.4.341. Source ↩
  4. Nathan H. Spine. 1987;12:527–532. doi:10.1097/00007632-198707000-00003. PubMed ↩
  5. MSD Manual Professional. Dysphagia. Reviewed February 2026. Source ↩
  6. Reinhold M et al. Global Spine Journal. 2018;8(2 Suppl):56S–68S. doi:10.1177/2192568217736268. Source ↩
  7. Okada E et al. Journal of Orthopaedic Science. 2019;24:601–606. doi:10.1016/j.jos.2018.12.017. PubMed ↩
  8. Kuperus JS et al. Radiology. 2019;291:420–426. doi:10.1148/radiol.2019181695. PubMed ↩

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