1028 - A DISH Best Served Warm; a Case of Cervical Diffuse Idiopathic Skeletal Hyperostosis

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

NT

Naveed Tariq, DO

PM&R Resident
Nassau University Medical Center
East Hempstead, New York, United States

Co-Author(s)

AZ

Aaron Zell, DO

PM&R PGY-2
Nassau University Medical Center
Copiague, New York, United States
MF

Michael Fedorovsky, DO

PM&R Resident
Nassau University Medical Center
East Rockaway, New York, United States
AA

Aruba Asad, DO

PM&R Resident
Nassau University Medical Center
Huntington Station, New York, United States

Submitter(s)

NT

NAVEED TARIQ, DO

Nassau University Medical Center
MELVILLE, New York, United States

Case Diagnosis: 78 year old female with a history of hypertension, hyperlipidemia, glaucoma, hyperparathyroidism, dementia, and neck pain was referred to our rehabilitation clinic for evaluation of neck pain with abnormal imaging. X-ray of the cervical spine and bilateral shoulders revealed Diffuse idiopathic skeletal hyperostosis (DISH) and bilateral AC joint arthropathy.

Case Description: The patient presented with five years of cervical neck pain with reduced range of motion in rotation, side bending, flexion and extension. Previous treatments included chiropractic therapy, physical therapy, and heat which reportedly helped pain. The patient reported worsening dyspneic 5/10 pain over past 2 years, globus sensation, dysphagia, as well as hoarse voice. She denied numbness in upper or lower extremities, bowel or bladder incontinence, or trauma to neck. Patient recommended to restart physical therapy, obtain MRI C-spine, referred to neurosurgery and ENT for mass effect on spinal cord and airway, respectively.

Discussions: DISH primarily affects older adults, especially men over 50. There is a strong association with metabolic conditions such as obesity, diabetes mellitus, and metabolic syndrome. Many individuals may be asymptomatic but some manifestations include back pain, spinal stiffness, reduced range of motion, and, like our patient, in the cervical spine, dysphagia due to esophageal compression. Rarely there may be airway obstruction. Diagnosis is based on imaging criteria such as the Resnick criteria. Due to ankylosing of the spine, patients are at an increased risk for unstable fractures. There are no specific pharmacologic therapies and management often focuses on symptom control, fracture prevention, and addressing metabolic comorbidities.

Conclusions: PM&R physicians are uniquely suited to manage and coordinate treatment of this condition due to the training received in musculoskeletal medicine, functional restoration, and non-surgical management. Further research is still needed to define optimum exercise regimens, safety parameters, and the impact of rehabilitation on long-term outcomes and quality of life.