Criteria for Early-Phase Diffuse Idiopathic Skeletal Hyperostosis: Development and Validation

Abstract

iffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the formation of new bone along the anterolateral spinal column (1). The lower thoracic spine is most frequently affected, and ossifications of peripheral entheses are also frequently present in DISH (1,2). The prevalence of DISH varies between 2.9% and 42.0%, depending on the criteria used, demographic background, and presence of associated factors (3-6). Risk factors for developing DISH are older age, metabolic derangement (hypertension, obesity, diabetes mellitus), and cardiovascular disease (1,4). The pathogenesis of DISH is unknown (1). The three criteria established by Resnick and Niwayama are the criteria most frequently used for the diagnosis of DISH and include bridging of four adjacent vertebral bodies by newly formed bone, without severe loss of the intervertebral disk height and without degeneration of the apophyseal and sacroiliac joints (3,7). The Resnick and Niwayama criteria were designed so as to include only "definite" cases of DISH in their study, excluding other spinal pathologies such as ankylosing spondylitis (7). As a consequence, the threshold criteria for DISH are high and therefore possibly reflect a late or even end stage of DISH (3). Longitudinal research on the natural course of DISH has exposed a process of slow, ongoing formation of new bone (8-10). Over time, the number of affected vertebral body segments increases

Scoring Osteoarthritis Reliably in Large Joints and the Spine Using Whole-Body CT: OsteoArthritis Computed Tomography-Score (OACT-Score)

“…Fifth, concurrent pathology such as diffuse idiopathic skeletal hyperostosis may aggravate OA scores. Grading systems for such concurrent diseases could be used along with the OA scores to further characterize individuals [ 37 , 38 , 39 ]. Sixth, CT involves exposure to possibly harmful ionizing radiation.…”

"Importance of Conventional Radiography in the Diagnosis of Diffuse Idiopathic Skeletal Hyperostosis"

“…Resnick et Nivayama, 1976, described the changes found by CR in patients with DISH and demonstrated that the disease is not limited to the spine [15]. In subsequent years, these findings were confirmed by other authors [16][17][18][19][20][21]. The authors note that changes initially occur in the lower right thoracic segment (around Th 9, 8, 7, 10).…”

Diffuse Idiopathic Skeletal Hyperostosis of Cervical Spine with Dysphagia—Molecular and Clinical Aspects

“…Criteria for diagnosis in research and clinical settings are controversial. In the research setting, it is recommended to completely exclude DISH cases from patients with comorbidities described in the Resnick and Niwayam exclusion criteria [ 4 , 58 ].…”