Research and evidence

Research on DISH is uneven. Imaging and fracture studies are relatively large, while evidence on treatment comes mostly from small case series. A 2017 review summarizes the uncertainty about how much DISH affects people, how to classify it and how to treat it1.

Imaging and classification

A CT study of more than 3,600 people developed and validated criteria for recognizing early DISH, checked against scans about five years later2. A CT study comparing 86 people with DISH and 85 without found that bridging around the sacroiliac joints can occur in DISH, so changes there don't rule it out3.

Exercise

In a small program, 15 of 17 participants completed 24 weeks of exercise. Physical measures improved slightly, with statistical significance only for bending of the lower back4.

Surgery for swallowing problems

In a series of 21 patients who had neck osteophytes removed for swallowing difficulty, 16 had improved at one month. Of 17 followed longer, three had a relapse of symptoms, and none needed a second operation5. In seven patients followed for an average of nine years, bone regrew in all of them, but five remained free of symptoms; two had swallowing problems again after ten or eleven years, and one needed another operation6. A review pooled 22 studies describing 119 patients7, and a small series described how patients were assessed and selected8.

Fractures in the fused spine

Recommendations from the German Orthopaedic and Trauma Society cover fractures in stiffened spines from DISH and ankylosing spondylitis, emphasizing that they can be unstable and hard to recognize9. A Japanese survey documented delayed diagnosis and later neurological deterioration10. A 2025 study reported that selected fractures healed without surgery under close specialist monitoring11.

Thoracic osteophytes

A 1987 cadaver study showed that thoracic osteophytes can compress the sympathetic trunk and splanchnic nerves12. A 2022 case report described relief of chest and upper abdominal pain after a thoracic osteophyte was removed13. A 2019 study found more calcification of the coronary arteries in people with DISH14. How often thoracic osteophytes cause symptoms, and the results of removing them, need further study.

Patient information

Cleveland Clinic explains the condition for patients15.

References

1. Mader R et al. RMD Open. 2017;3:e000472. doi:10.1136/rmdopen-2017-000472. Source ↩
2. Kuperus JS et al. Radiology. 2019;291:420–426. doi:10.1148/radiol.2019181695. PubMed ↩
3. Yahara Y et al. BMC Musculoskeletal Disorders. 2020;21:93. doi:10.1186/s12891-020-3105-z. Source ↩
4. Al-Herz A et al. Clinical Rheumatology. 2008;27:207–210. doi:10.1007/s10067-007-0693-z. PubMed ↩
5. Chung YS et al. Yonsei Medical Journal. 2020;61:341–348. doi:10.3349/ymj.2020.61.4.341. Source ↩
6. Miyamoto K et al. European Spine Journal. 2009;18:1652–1658. doi:10.1007/s00586-009-1133-3. PubMed ↩
7. Gendreau JL et al. Clinical Spine Surgery. 2021;34:220–227. doi:10.1097/BSD.0000000000001105. PubMed ↩
8. Yoshioka K et al. Spine Surgery and Related Research. 2018;2:197–201. doi:10.22603/ssrr.2017-0045. Source ↩
9. Reinhold M et al. Global Spine Journal. 2018;8(2 Suppl):56S–68S. doi:10.1177/2192568217736268. Source ↩
10. Okada E et al. Journal of Orthopaedic Science. 2019;24:601–606. doi:10.1016/j.jos.2018.12.017. PubMed ↩
11. Do All Fractures in the Ankylotic Spine Really Require Surgical Intervention? Journal of Clinical Medicine. 2025;14:5599. doi:10.3390/jcm14155599. Source ↩
12. Nathan H. Spine. 1987;12:527–532. doi:10.1097/00007632-198707000-00003. PubMed ↩
13. Jankowski J, Pawełczyk A, Radek M. Neurochirurgie. 2022;68:232–234. Online 2021. doi:10.1016/j.neuchi.2021.02.017. PubMed ↩
14. Oudkerk SF et al. Atherosclerosis. 2019;287:24–29. doi:10.1016/j.atherosclerosis.2019.05.030. PubMed ↩
15. Cleveland Clinic. Diffuse Idiopathic Skeletal Hyperostosis. Updated 28 April 2024. Source ↩