Management of Diffuse Idiopathic Skeletal Hyperostosis of the Spine

Purpose of ReviewDiffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory condition associated with the ossification and calcification of spinal ligaments and peripheral entheses. Management of mild symptoms is often conservative, though surgical intervention has been implicated for patients with debilitating symptoms. This literature review aims to review current management concepts of patients with DISH, including both conservative and surgical treatment options. Studies utilizing conservative treatment included pharmacotherapy, physical therapy, orthosis immobilization, or chiropractor manipulation.Recent FindingsConservative management of DISH is often performed for patients who do not have unstable spine fractures or neurological deficits. Orthosis immobilization and physical therapy have been found to improve symptoms associated with DISH (back pain, stiffness); however, brace compliance is reported to be a strong predictor of clinical outcomes. For patients with symptoms refractory to conservative treatment or presented with airway compromise or neurological deficits, surgical management can yield good outcomes. Several studies have reported improvement in dysphagia and dyspnea following resection of cervical osteophytes in patients with DISH.SummaryAlthough the primary treatment for DISH is typically nonoperative, surgical intervention can provide effective treatment that results in favorable outcomes. Surgery may be recommended for patients who fail to recover after conservative management or for patients with unstable spine fractures complicated by neurological deficits, respiratory symptoms, or dysphagia.