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Diffuse Idiopathic Skeletal Hyperostosis

- Discussion:
    - also known as Forestier's disease;
    - disease involves non-marginal syndesmophytes present at at three successful vertebral levels;
          - commonly there will be no disc & joint narrowing & nor osteoarthritis;
          - differentiated from AS, w/ marginal syndesmophytes;
    - more common in elderly men;
    - DISH is associated w/ low back pain and is more common in patients w/ diabetes and gout;
    - prevelance of DISH may be as high as 28%;

- Associated Conditions:
    - associatted with extrapsinal ossification in large joints;
    - osteophytes are seen at extravertebral sites, esp margins of large joints;
    - increased risk of hetertopic ossification following THR;

- Location of Syndesmophytes:
    - can occur anywhere in the spine;
    - most common in thoracic spine;
    - more often seen on the right side;
    - cervical spine involvement:
          - frequently involved;
          - characterized by thick, wavy ossification of anterior longitudinal ligament;
          - relative preservation of the disk spaces;
          - no vaccum phenomena or vertebral end plate sclerosis

Hyperextension Injuries of the Thoracic Spine in Diffuse Idiopathic Skeletal Hyperostosis.  Report of Four Cases.