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Are New Diagnostic Criteria Needed? Diffuse Idiopathic Skeletal Hyperostosis Concealed by Cervical Radiculopathy: A
Tejas Shah1, Hassan Aboumerhi2,3
1Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, PA.
Background:
Diffuse idiopathic skeletal hyperostosis (DISH) involves widespread ossification of ligaments in the skeleton with associated nonspecific symptoms. Cervical DISH may result in dysphagia and orthopnea but can be missed with accompanying spinal pathology.
Case Report:
A 52 year-old man with a history of coronary artery disease presented with worsening neck pain radiating to the bilateral upper extremities. Magnetic resonance imaging revealed ventral osteophytes at C3-C7 and moderate stenosis at C4-C5. The patient underwent cervical epidural steroid injections resulting in partial pain relief. However, axial neck pain persisted and he reported new-onset dysphagia and orthopnea. Subsequent imaging showed C2-C7 anterior osteophytes with tracheal displacement, confirming the DISH diagnosis. The patient underwent resection of the osteophytes and had subsequent complete symptom resolution.
Conclusion:
Although radicular symptoms improved with an injection, dysphagia not previously mentioned was concerning. DISH is routinely missed in the setting of spinal pathology, such as radiculopathy. The presence of anterior cervical spine osteophytes should prompt further respiratory or swallow evaluation.
