Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Reviewed by Dr. Kshitij Chaudhary, Spine Surgeon, P.D. Hinduja Hospital, Mumbai. Last reviewed June 2026.

What Is DISH?

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition in which extra bone forms along the ligaments of the spine, most often in the upper-to-mid back. Despite the formal name, it's a relatively common, usually painless condition, particularly in older adults — many people are diagnosed incidentally when an X-ray is done for another reason.

What Causes It?

The exact cause isn't known, though it's associated with metabolic factors such as diabetes and obesity. Bone spurs ("hyperostosis") form where ligaments attach to the spine, and sometimes at other joints — hips, knees, shoulders, heels.

Common Symptoms

Many people with DISH have no symptoms at all. When symptoms occur:

• Stiffness and mild pain in the upper back or neck
• Reduced spinal flexibility
• In more advanced cases involving the neck, bone spurs can occasionally press on the esophagus, causing difficulty swallowing, or rarely affect breathing

How Is It Diagnosed?

DISH is diagnosed on X-rays or CT scans, which show characteristic flowing bone formation along the front of the spine, distinguishing it from other arthritic conditions.

Treatment

DISH itself can't be reversed, but symptoms are very manageable:

• Physiotherapy to maintain flexibility
• Anti-inflammatory medication for pain
• Heat therapy for stiffness, particularly in the morning

Surgery is rarely needed, and reserved only for cases where bone spurs are causing significant swallowing difficulty, breathing problems, or nerve compression.

Frequently Asked Questions

Is DISH a serious condition?

For most people, no — it's often an incidental finding that causes mild stiffness at most. It's worth knowing about mainly because of its (uncommon) effects on swallowing or nearby nerves in advanced cases.

Is DISH the same as ankylosing spondylitis?

No, though the two can look similar on imaging. They're distinct conditions with different underlying causes and patterns of involvement.

Will DISH get worse over time?

It can slowly progress, but this is usually gradual over years, and many people remain symptom-free.

When Should You Seek Medical Attention?

See a doctor if you develop new difficulty swallowing, hoarseness, or any limb numbness, weakness, or balance changes.

About Dr. Kshitij Chaudhary

This page was written by Dr. Kshitij Chaudhary, a fellowship-trained spine surgeon at P.D. Hinduja Hospital, Mumbai, trained in complex spine surgery at Harvard Medical School (Beth Israel Deaconess) and the Twin Cities Spine Center, Minneapolis. Learn more about Dr. Chaudhary →

This information is for general education and does not replace a consultation with your doctor.