Diffuse idiopathic skeletal hyperostosis (DISH) causing spinal stenosis and sudden paraplegia

Area of Science:

• Neurology
• Rheumatology
• Spinal Surgery

Background:

• Diffuse idiopathic skeletal hyperostosis (Forestier's disease) is a non-inflammatory condition characterized by excessive bone formation along the spine.
• It can be misdiagnosed, particularly when presenting with symptoms overlapping with inflammatory arthropathies like ankylosing spondylitis.
• Spinal cord compression is a rare but serious complication of Forestier's disease.

Observation:

• A patient diagnosed with Forestier's disease experienced neurologic complications.
• These complications stemmed from spinal cord compression.
• The initial presentation was misdiagnosed as ankylosing spondylitis.

Findings:

• Emergency laminectomy was performed to address the spinal cord compression.
• The surgical intervention successfully halted the progression of neurologic symptoms.
• The patient demonstrated slow but steady improvement following the procedure.

Implications:

• Highlights the importance of considering Forestier's disease in the differential diagnosis of spinal pathologies, even when symptoms mimic other conditions.
• Underscores the efficacy of prompt surgical decompression in managing neurologic deficits caused by spinal cord compression in Forestier's disease.
• Suggests that early recognition and intervention can lead to favorable outcomes for patients with this rare complication.