Presentation
This man presented with neck and shoulder pain, more on the left side.
Patient Data
Age: 60 years
Gender: Male
From the case:
Diffuse idiopathic skeletal hyperostosis
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Lateral radiograph of the cervical spine shows exuberant ossification of the anterior longitudinal ligament and flowing bridging anterior osteophytosis.
The intervertebral disc spaces are preserved. The vertebral bodies heights are preserved.
No fracture or dislocation.
Case Discussion
Key points to differentiate diffuse idiopathic skeletal hyperostosis (DISH) from ankylosing spondylitis (AS) or ossification of the posterior longitudinal ligament (OPLL):
- dense ossification of anterior longitudinal ligament with or without osteophytes (versus fine calcification of the annulus fibrosis in AS)
- at least four contiguous vertebral bodies involved
- intervertebral disc spaces maintained
- ossification of the superior portion of sacroiliac joints, pelvic ligaments and posterior longitudinal ligament (versus posterior longitudinal ligament ossification with bulky anterior osteophyte formation in OPLL)
Special thanks to Dr Tamer Elholiby.
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