Diffuse Idiopathic Skeletal Hyperostosis (DISH)

DISH means extra bone has formed along the ligaments of your spine. It is common, often painless and usually found by chance on an X-ray. Most people need only exercise and simple pain relief, and surgery is rarely needed.

Reviewed by Dr. Kshitij Chaudhary, Last reviewed October 2026

What is DISH?

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition where extra bone grows along the ligaments at the front and side of the spine. Over time, the new bone can link several vertebrae into a stiff column. It is most common in the middle of the back (thoracic spine), and it can also affect the neck and lower back. Some people have it at the heels, elbows, shoulders or hips too. "Idiopathic" means we don't know the exact cause.

What causes it, and who gets it?

The exact cause isn't known. DISH becomes more common after age 50, and men get it more often than women. It is linked to type 2 diabetes, being overweight and other metabolic problems. It isn't an infection, and nothing you did caused it.

How serious is it?

For most people, it is not serious. Many people have no symptoms and never need treatment. It matters mainly because of stiffness, a few uncommon problems when new bone grows large at the front of the neck, and one more point covered below: a stiff spine can break more easily after a fall.

What are the symptoms?

Many people have none. When symptoms do appear, they can include:

• Stiffness and mild pain in the upper back or neck, often worse in the morning
• Less bending and turning in the spine
• Pain where tendons meet bone, such as the heel, elbow or shoulder
• Trouble swallowing, a hoarse voice or, rarely, noisy breathing, when new bone at the front of the neck presses on the food pipe or windpipe
• Rarely, numbness, tingling or weakness, when extra bone narrows the spinal canal

How is it diagnosed?

DISH is usually found on an X-ray or CT scan. The typical sign is smooth, flowing new bone along the front and usually the right side of at least four vertebrae in a row. The discs between them are usually still healthy. An MRI is added if there is nerve pressure or a suspected fracture. We may also check your blood sugar, because diabetes is common with DISH.

Is DISH the same as ankylosing spondylitis?

No, though the two can look alike on scans. They are different conditions.

Will it get worse?

DISH usually changes slowly, over years, and many people stay free of symptoms. Stiffness can increase gradually. It doesn't spread through the body, and it doesn't damage the discs.

How is it treated without surgery?

Symptoms are very manageable. Treatment usually includes:

• Staying active: Keep moving every day. Walking and gentle stretching help to keep the spine flexible
• Physiotherapy: Exercises for movement and posture. See the Spine Conditioning Programme
• Medicines: Paracetamol and anti-inflammatory tablets can ease pain. Do not use anti-inflammatory tablets for more than about 10 days in a row without asking your doctor
• Heat: A warm pack helps morning stiffness
• Blood sugar and weight: Keeping both under control may slow the condition
• Swallowing: A soft diet and swallowing therapy help, and we refer you to a specialist if needed

When is surgery needed?

Rarely. It is considered when new bone is causing real swallowing or breathing problems, when it presses on the spinal cord or nerves, or when the stiff spine has fractured. If you have been advised surgery and aren't sure, you can send your MRI for a second opinion before deciding.

What does surgery involve?

The operation depends on the problem:

• Swallowing problems: The surgeon removes the extra bone at the front of the neck so the food pipe has room
• Nerve or cord pressure: The surgeon removes the bone pressing on the nerves. This is described on the Cervical Spinal Stenosis and Lumbar Spinal Stenosis pages
• A fracture: A stiff spine acts like a long lever, so we usually fix it with screws and rods over several levels above and below the break

We will explain which operation suits you, and why.

Can DISH be prevented?

Not fully. Staying active and keeping blood sugar and weight healthy are good for your spine, and may slow DISH down.

Questions to ask your doctor

• Do my scans show DISH, or could it be another condition?
• Is any nerve or the food pipe affected?
• What exercises are right for me?
• What should I do if I fall or hurt my back?
• Should my blood sugar and weight be checked?

Treatments we offer for this

Physiotherapy guidance, medicines, and spinal decompression or stabilisation surgery for the few people who need it.

This page is for general information and does not replace a medical consultation. Please see a doctor for advice about your own symptoms.