Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Related Dysphagia: Two Case Reports with a Comprehensive Literature Review

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among the elderly. It is a well-defined syndrome with axial and peripheral skeletal manifestations including hyperostosis at the tendon insertions site around the joint capsules as well as the ossification of the anterior longitudinal ligament (ALL) of the spine. The bridged ossified anterior longitudinal ligament may infrequently cause swallowing difficulties and respiratory distress. The initial complication is due to excessively enlarged cervical osteophytes at the cervical-subaxial level and at or below C4 with a compression of esophagus. The subsequent complications are usually secondary to enlarged spurs above C4. In this paper we discuss two cases where the patients have experienced progressive dysphagia for one year and in which radiological findings were compatible with DISH from C2-C7 with the largest existing at C4. Surgical excision of the prominent osteophytes resulted in improvement of the dysphagia in both cases.