Medical expert of the article
New publications
Diffuse idiopathic skeletal hyperostosis
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Diffuse idiopathic skeletal hyperostosis (DISG) is a disease of the ligamentous apparatus of the spine. The cause of DISG is unknown. Sign of the disease is a continuous ossification of ligamentous structures of the spine, which extends at least three vertebral spaces. More often, diffuse idiopathic skeletal hyperostosis develops in the thoraco-lumbar region, but it can also affect the cervical spine, ribs and pelvic bones.
Diffuse idiopathic skeletal hyperostosis causes stiffness and pain in the cervical and thoraco-lumbar spine. Symptoms increase with awakening and at night. When the disease affects the cervical spine, cervical myelopathy may develop. When the front structures of the cervical spine are involved, dysphagia may appear. Diffuse idiopathic skeletal hyperostosis occurs at the age of 50-60 years. It can also cause stenosis of the spinal canal with ingermittitating lameness. Men get sick twice as often. The disease is more susceptible to the Caucasoid race. In patients with DISH, diabetes mellitus, hypertension and obesity are more common than in the population as a whole. Diffuse idiopathic skeletal hyperostosis is usually diagnosed during the radiography of the spine.
Symptoms of diffuse idiopathic skeletal hyperostosis
Patients with DISH complain of stiffness and pain in the affected segment of the spine or bone. Also, patients can pay attention to numbness, weakness, impaired coordination in the extremities innervated by the affected segment. Often there are muscle spasms and back pain, which irradiates into the same area. Sometimes patients with DISH experience compression to the pinnacle, nerve root and horse tail, which leads to myelopathy or horse tail syndrome. Diffuse idiopathic skeletal hyperostosis is the second most frequent cause of cervical myelopathy after cervical spondylosis. Patients suffering from lumbar myelopathy or horse tail syndrome have varying degrees of weakness in the limbs and symptoms of dysfunction of the bladder and intestines, which is an urgent neurosurgical situation and requires appropriate treatment.
Examination
Diffuse idiopathic skeletal hyperostosis is diagnosed during radiography. The pathognomonic symptom is a continuous ossification of ligamentous structures of the spine, extending at least 3 segments. The height of the intervertebral disc is preserved. With suspicion and myelopathy, MRI gives the clinician the most complete information about the state of the spinal cord and spinal roots. MRI is highly reliable and helps to identify another pathology capable of exposing a patient to the risk of developing irreversible damage to the spinal cord. Patients who are contraindicated in MRI (the presence of pacemakers) as a second choice shows CT or myelography. Radionuclide studies of bone or radiography are indicated for suspected fractures or bone pathologies.
These survey methods give the clinician useful information about the neuroanatomy, and electromyography and study of nerve conduction speed provide data on neurophysiology that can establish the current status of each nerve root and lumbar plexus. Laboratory tests, including a general blood test. ESR. A biochemical blood test should be performed if the diagnosis of "diffuse idiopathic skeletal hyperostosis" is uncertain.
Complications and Diagnostic Errors
Failure to accurately diagnose diffuse idiopathic skeletal hyperostosis can expose the patient to the risk of developing myelopathy, which, if untreated, may progress to paraparesis or paraplegia. Electromyography helps to distinguish between plexopathy and radiculopathy and to diagnose existing tunneling neuropathy, which can distort the diagnosis.
Given the association of diffuse idiopathic skeletal hyperostosis with multiple myeloma and Paget's disease, these potentially life-threatening conditions must be included in the differential diagnosis. Diffuse idiopathic skeletal hyperostosis can exist simultaneously with degenerative arthritis and discogenic disease. Each disease requires its own specific treatment.
[8],
Differential diagnosis of diffuse idiopathic skeletal hyperostosis
Diffuse idiopathic skeletal hyperostosis is an x-ray diagnosis, which is confirmed by a combination of anamnesis, physical examination and MRI data. Pain syndromes that can mimic a diffuse idiopathic skeletal hyperostosis include stretching the neck and lower back, inflammatory arthritis, ankylosing spondylitis, diseases of the spinal cord, roots, plexuses and nerves. 30% of patients with multiple myeloma or Paget's disease suffer DISG. A laboratory test should be conducted that includes a general blood test, ESR, antinuclear antibodies, HLA B-27 antigen and a biochemical blood test to exclude other causes of pain if the diagnosis of diffuse idiopathic skeletal hyperostosis is uncertain.
Treatment of diffuse idiopathic skeletal hyperostosis
In the treatment of diffuse idiopathic skeletal hyperostosis, a multicomponent approach is most effective. Physiotherapy, which includes thermal procedures. Moderate physical activity and deep relaxing massage in combination with NSAIDs and muscle relaxants (eg, tizanidine) are the most preferred treatment start. With persistent pain, an epidural blockade is indicated. In the treatment of background sleep disorders and depression, tricyclic antidepressants, such as amitriptyline, which can be treated with 25 mg per night