Diffuse Idiopathic Skeletal Hyperostosis (DISH) With Cervical Myelopathy: A Case Report From Sudan

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition characterized by ossification of spinal ligaments, commonly affecting elderly individuals. While often asymptomatic, it may present severe neurological deficits due to spinal cord compression. We report what is believed to be the first documented case of DISH presenting with cervical myelopathy in Sudan. A 73-year-old diabetic man presented with progressive weakness in all limbs, accompanied by neck and back pain. Neurological examination revealed spastic quadriparesis, sensory loss to proprioception and vibration, and signs consistent with cervical myelopathy. No bowel or bladder involvement was reported. Imaging studies including CT and MRI of the spine demonstrated ossification of the anterior and posterior longitudinal ligaments throughout the cervical region, with severe spinal canal stenosis at C5-C7. Additional lumbar stenosis due to ligamentum flavum hypertrophy was also noted. A diagnosis of DISH with cervical myelopathy and lumbar stenosis was made. Surgical decompression was planned; however, the patient died unexpectedly before the planned intervention. DISH with cervical myelopathy is rarely encountered in clinical practice and has traditionally been considered more prevalent among Asian populations; however, we report what is, to our knowledge, the first documented case of DISH with cervical myelopathy in Sudan. This case report underscores the importance of early recognition of DISH in settings where it is rarely reported, in order to improve clinical outcomes. Furthermore, this case report highlights the need for further epidemiological and clinical studies in the country to assess the prevalence, risk factors, and management outcomes associated with this underrecognized rheumatologic disorder.