Two spinal conditions that are often mistaken for one another are Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Ankylosing Spondylitis (AS). Although they can present with similar symptoms initially, there are important differences that your chiropractor evaluates to ensure appropriate care and management.
What is DISH?
Diffuse Idiopathic Skeletal Hyperostosis, often shortened to DISH, is a condition where excessive calcification develops along the ligaments of the spine, particularly the anterior longitudinal ligament which runs the length of the whole spine. Over time, this can create large bony bridges between vertebrae, reducing spinal mobility.
DISH is more commonly seen in older adults and is often associated with metabolic conditions such as type 2 diabetes, obesity, and high cholesterol. Many people with DISH may not realise they have the condition as it typically limits mobility without pain. It isn’t until imaging, like x-rays are taken that it is confirmed.
What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) is an inflammatory autoimmune condition that primarily affects the sacroiliac joints and spine. It belongs to a group of conditions known as spondyloarthropathies, where inflammation causes pain, stiffness, and over time may progress to fusion of joints if left unmanaged.
Unlike DISH, AS often begins in younger adults, commonly between the ages of 15 and 40.
Similarities in Presentation
Although the causes are very different, DISH and AS can appear similar initially.
Both conditions affect the spine and may present with:
- Persistent spinal stiffness
- Reduced range of motion
- Postural changes
- Back pain that may worsen over time
- Calcification and spinal changes visible on imaging
As the spine becomes less mobile, patients may also experience difficulty with everyday movements such as twisting, bending, or looking over the shoulder while driving.
Key Differences
Despite these similarities, there are several important differences between DISH and AS that your chiropractor will evaluate.
Age of Onset
DISH is usually diagnosed later in life, typically after the age of 45. Whereas AS commonly develops in younger adults.
Cause
DISH is considered a non-inflammatory condition involving abnormal bone growth and is associated with diabetes and obesity.
AS is an inflammatory autoimmune disease where over time the chronic inflammation creates structural changes to the bones and soft tissue. Often there is also a family history of AS or other inflammatory diseases such as psoriasis or Crohn’s disease.
Symptoms
DISH symptoms are often more mechanical in nature, with stiffness and restricted movement being more prominent than inflammatory pain.
In contrast, people with AS often report morning stiffness and pain that improves with movement and anti-inflammatory medication. They may also experience fatigue, inflammation, or pain in other joints like the shoulders or hips.
Imaging Findings
X-rays play a major role in distinguishing the two conditions and is a tool your chiropractor will likely use in your assessment.
As an overview, DISH typically shows flowing calcification along the front of the spine while preserving the disc spaces and sacroiliac joints.
AS commonly affects the sacroiliac joints and may produce the classic “bamboo spine” appearance due to spinal fusion, as well as visible changes to the vertebral discs.
Patient Outcomes
Both conditions can have a significant impact on quality of life and daily function if not managed appropriately.
AS may progressively reduce spinal mobility and lead to spinal fusion. However, with early diagnosis and management, many patients are able to maintain a good level of function and physical activity.
DISH often progresses more slowly, but the stiffness and reduced flexibility can still affect posture, mobility, and daily activities.
Management and Chiropractic Care
Chiropractic care for both conditions is aimed at supporting the body and spine by maintaining mobility, reducing discomfort, and improving function.
Your chiropractor will thoroughly examine your spine and nervous system based on your presentation to ensure care is appropriate and tailored to your body.
They will use a combination of chiropractic techniques which play a supportive role in managing these conditions when appropriate for the patient. Treatment may include:
- Gentle mobilisations
- Low force adjustments
- Use of Activator or Arthrostim instruments
- Soft tissue release
- Exercises to target strength and function for supporting the spine
- Mobility and stretching programs
- Education around movement and spinal health
Because AS is an inflammatory autoimmune condition, treatment may also include anti-inflammatory medications and support from other healthcare professionals.
The good news is that with a comprehensive assessment and an individualised care plan, you can successfully manage these conditions and continue doing the things that matter most to you.
Be sure to ask our friendly team of chiropractors about your spinal health!