Cervical cord compression in diffuse idiopathic skeletal hyperostosis.

Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively common disorder predominating in men (65 to 70 percent),i with a prevalence of approximately 3 percent in adults older than 40 years of age2 and from 12 percent to 15 percent in patients more than 65 years of age.3,4 In 1950 Forestier and Rotes-Querol5 introduced the term senile ankylosing hyperostosis of the spine. DISH has long been regarded as a radiographic entity characterized by calcification and ossification of the anterolateral aspects of the vertebral column whose clinical manifestations (usually thoracolumbar or cervical stiffness) are minor and of little consequence. Some severe neurologic complications, however, resulting from spinal cord compression have been recently reported.6-B Typically, ossification of the posterior longitudinalligament of the spine has not been considered a component of this process, and its prevalence is estimated to be approximately 6 percent in individuals more than 65 years of age.9 Nevertheless, Resnick, et al.lO reported that ossification of the posterior longitudinal ligament occurs in 50 percent of patients suffering from DISH. Reported here is a patient who experienced progressive quadriparesis. Diagnostic studies evidenced the existence of both disorders. A brief discussion and recommended strategies follow.