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Review Question - QID 1041

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QID 1041 (Type "1041" in App Search)
A 60-year-old man presents with neck stiffness and difficulty swallowing. A lateral radiograph is shown in Figure A. What is the most likely diagnosis?
  • A

Ankylosing spondylitis

7%

281/4183

Cervical myelopathy

0%

17/4183

Congenital spinal stenosis

1%

22/4183

Diffuse idiopathic skeletal hyperostosis

91%

3801/4183

Ossification of posterior longitudinal ligament

1%

38/4183

  • A

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Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder of unknown etiology that is characterized by back pain and spinal stiffness.

The condition is recognized radiographically by the presence of "flowing" ossification along the anterolateral margins of at least four contiguous vertebrae and the absence of changes of spondyloarthropathy or degenerative spondylosis. It is a challenge to differentiate between DISH and ankylosing spondylitis.

Features that help distinguish DISH from AS include: 1) nonmarginal syndesmophytes as shown in Illustration A (AS is marginal). 2) no involvement of SI joint (biliateral sacroiliitis in AS). 3) anterior cervical bone formation with preservation of disc space as seen in Illustration B (AS will typicall show bone formation between vertebral bodies as seen in Illustration C). 4) Radiographic findings on the right side of the thoracic spine.

The reference by Belanger et al is a review article that discusses the diagnosis and treatment of both spinal and extraspinal manifestations of DISH.

The reference by di Girolamo et al found an increased prevalence of vertebral osteochondrosis (degenerative disc disease) in younger DISH patients with respect to controls.

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