Two Cases Report of Dysphagia Due to Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among the elderly. It is a well-defined syndrome with axial 
and peripheral skeletal manifestations including hyperostosis at the tendon insertions site around the joint capsules as well as the 
ossification of the anterior longitudinal ligament (ALL) of the spine. The bridged ossified anterior longitudinal ligament may 
infrequently cause swallowing difficulties and respiratory distress. The initial complication is due to excessively enlarged cervical 
osteophytes at the cervical-subaxial level and at or below C4 with a compression of esophagus. The subsequent complications are 
usually secondary to enlarged spurs above C4. In this paper we discuss two cases where the patients have experienced progressive 
dysphagia for one year and in which radiological findings were compatible with DISH from C2-C7 with the largest existing at C4. 
Surgical excision of the prominent osteophytes resulted in improvement of the dysphagia in both cases.