Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection?

The role of diffuse idiopathic skeletal hyperostosis (DISH) in positive identification

“…DISH, previously known as Forestier's disease, is a noninflammatory spinal enthesopathy that is common in older adults and occurs most frequently in the thoracic spine; however, it can also occur in the cervical and lumbar spine [19][20][21][22][23][24][25][26][27]. DISH is characterized by bridging ossifications that grow on the right anterolateral margin of the spine and are often described as resembling dripping candlewax [19][20][21][22][23][24][25][26][28][29][30][31][32][33][34]. Peripheral entheses may also present on the pelvis, patella, olecranon, and calcaneus [30].…”

“…DISH is characterized by bridging ossifications that grow on the right anterolateral margin of the spine and are often described as resembling dripping candlewax [19][20][21][22][23][24][25][26][28][29][30][31][32][33][34]. Peripheral entheses may also present on the pelvis, patella, olecranon, and calcaneus [30]. These ossifications or enthesophytes can vary in their size, shape, and manifestation between individuals.…”

“…These ossifications or enthesophytes can vary in their size, shape, and manifestation between individuals. Individuals with DISH are often asymptomatic [19,20,30,33,[35][36][37], leaving many diagnoses unnoticed or discovered during unrelated medical evaluations. In paleopathology, DISH has been identified in numerous skeletal samples spanning from ancient Northern Chile [28], Byzantine Greece [34], Joseon Dynasty Korea [38], and all throughout Europe [22,27,39].…”

“…Khan et al [35] found that the prevalence of DISH in individuals aged 70 years and above was 11%, versus a reported 3%-6% in individuals aged 40 years and above. The prevalence of DISH is also significantly influenced by sex, wherein males have a higher prevalence than females, even within the same population [26,30,43]. Additionally, the presence of DISH in Midwestern U.S. hospital samples was higher in white individuals than in Black, Native American, or Asian individuals [42].…”

“…DISH is radiographically diagnosed and often follows the diagnostic criteria, or a modification thereof, created by Resnick and Niwayama [31]: (1) Flowing ossifications on the anterolateral margin of four or more consecutive vertebrae (i.e., dripping candlewax appearance); (2) Preserved intervertebral distance; and (3) Absence of other spinal conditions affecting spinal joints (see also: [20,21,[23][24][25][26]30,32,33,37]). Some believe that the use of these criteria is too restrictive, representing only those individuals who are affected by late-stage DISH [25].…”