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Begin with the aim of care

Treatment may address comfort and function, a specific compressive complication, or the stability of an injured spine. These aims are different. An operation to remove an obstructing osteophyte does not cure the systemic tendency to form new bone. Incidental radiographic DISH is not itself a routine surgical indication.1

Conservative care

Clinician-led symptom care may include physical therapy, functional adaptations and medicines chosen for the person's pain and other health conditions. Rehabilitation aims at useful movement and activities rather than forcing a fused segment to move.1

The DISH-specific exercise evidence is limited. A small uncontrolled program had 15 of 17 participants complete 24 weeks and reported small physical improvements, with statistical significance only for lumbosacral flexion. It does not prove reversal of bone bridges or establish a safe exercise plan for every person.2

Metabolic conditions should receive appropriate care for their own health consequences. Associations do not prove that diet, supplements or a metabolic intervention reverses DISH. Proposed bisphosphonate or biological treatments are not established systemic cures; AS biologic evidence cannot simply be applied to DISH.1

Cervical osteophytectomy for dysphagia

The goal is relief of a swallowing problem attributable to anterior cervical bone, after assessing alternative causes. The assessment can involve ENT, swallowing professionals and a spine team. Resection extent, any need for fusion and airway planning are individualized surgical decisions. Small series cannot reliably establish which technique is best.3

Chung's retrospective series reported improvement in 16 of 21 included cervical surgical cases at one month. Later complete follow-up was available for 17; three had symptom relapse and none underwent another operation during that reported follow-up. The paper's 29.5-month summary is inconsistently called mean or median. These observations concern selected dysphagia cases, with no untreated comparator.4

The same cohort reported hoarseness, including a persistent case, and transient weakness. Absence of major injury in a small series cannot prove zero risk. Swallowing or voice worsening, incomplete benefit, injury to nearby structures, anesthesia risks and possible further surgery need a patient-specific consent discussion.4

Longer-term cervical evidence also matters: Miyamoto followed seven patients for a mean nine years. All had radiographic regrowth; two developed recurrent dysphagia at ten/eleven years and one required reoperation at eleven years. These are separate endpoints, not a universal timetable.5

Thoracic osteophytes and the sympathetic nerves

In the chest, DISH osteophytes form along the sides of the vertebrae, close to the sympathetic trunk and the splanchnic nerves, which carry nerve signals to and from the heart and the abdominal organs. A 1987 study of cadavers showed that thoracic osteophytes can compress these nerves6. Whether that compression causes symptoms in living people has been studied very little. A 2022 report described one patient with chest and upper abdominal pain from a T8–T9 osteophyte whose pain improved after it was removed, with the benefit maintained at two years7. DISH is also associated with calcification of the coronary arteries8, but that is a separate finding and doesn't show that the osteophytes affect the heart.

Dr. Kamran Aghayev, who edits DISH Disease Wiki, removes thoracic osteophytes through the side of the chest, usually from the right, with the lung temporarily deflated, in patients whose pain or other symptoms he attributes to compression of the sympathetic nerves9. No case series of this operation has been published yet, so there are no published results to summarize.

Before thoracic surgery, ask the team which problem the operation targets, how other causes of the symptoms were ruled out, what the alternatives are, what benefit to expect, and the risks to the lung, airway and nerves. The results of neck surgery for swallowing problems can't answer these questions.

Fracture stabilization is another operation

An ankylosed-spine fracture may require stabilization or decompression for reasons quite different from elective bone-spur removal. The injury pattern, neurological findings, stability and general health determine the plan. Kyphoplasty is not a blanket stabilization answer for unstable DISH fractures.10

References

  1. Mader R et al. RMD Open. 2017;3:e000472. doi:10.1136/rmdopen-2017-000472. Source ↩
  2. Al-Herz A et al. Clinical Rheumatology. 2008;27:207–210. doi:10.1007/s10067-007-0693-z. PubMed ↩
  3. Yoshioka K et al. Spine Surgery and Related Research. 2018;2:197–201. doi:10.22603/ssrr.2017-0045. Source ↩
  4. Chung YS et al. Yonsei Medical Journal. 2020;61:341–348. doi:10.3349/ymj.2020.61.4.341. Source ↩
  5. Miyamoto K et al. European Spine Journal. 2009;18:1652–1658. doi:10.1007/s00586-009-1133-3. PubMed ↩
  6. Nathan H. Spine. 1987;12:527–532. doi:10.1097/00007632-198707000-00003. PubMed ↩
  7. Jankowski J, Pawełczyk A, Radek M. Neurochirurgie. 2022;68:232–234. Online 2021. doi:10.1016/j.neuchi.2021.02.017. PubMed ↩
  8. Oudkerk SF et al. Atherosclerosis. 2019;287:24–29. doi:10.1016/j.atherosclerosis.2019.05.030. PubMed ↩
  9. Dr. Kamran Aghayev practice website. DISH Disease Treatment. Page dated 20 November 2024. Source ↩
  10. Reinhold M et al. Global Spine Journal. 2018;8(2 Suppl):56S–68S. doi:10.1177/2192568217736268. Source ↩