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© 1989 British Society for Rheumatology

research-article

DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH) OF THE SPINE: A CAUSE OF BACK PAIN? A CONTROLLED STUDY

P. SCHLAPBACH*,, CH. BEYELER*, N. J. GERBER*, SJ. VAN DER LINDEN*, U. BÜRGI{dagger}, W. A. FUCHS{ddagger} and H. EHRENGRUBER§

*Department of Rheumatology, University of Bern Inselspital, CH-3010 Bern, Switzerland
{dagger}Department of Internal Medicine, University of Bern Inselspital, CH-3010 Bern, Switzerland
{ddagger}Department of Radiology, University of Bern Inselspital, CH-3010 Bern, Switzerland
§Department of Electronic Data Processing, University of Bern Inselspital, CH-3010 Bern, Switzerland

Correspondence to: Correspondence to Dr. Schlapbach

This is the first controlled study of the frequency of back pain in a European caucasian population with diffuse idiopathic skeletal hyperostosis (DISH).

Elderly patients admitted to hospital for reasons other than back pain were assessed for the presence of spinal DISH using the routine lateral chest radiograph films. A total of 106 probands (82 males, 24 females) with a mean age of 70 years fulfilled the criteria for DISH as defined previously. One hundred and seventyeight patients (117 males, 61 females) not meeting these criteria were used as controls. The prevalence of back pain was assessed by a blinded interviewer using a structured questionnaire. Our primary hymthesis was that spinal DISH positive probands had not had back pain more often than controls. The controlled study showed no statistically significant difference in pain frequency between spinal DISH positive probands and controls at any spinal level.

We conclude that back pain does not occur more often in radiographically defined DISH positive probands than in controls. The radiological finding of spinal DISH, as far as it does not lead to stenosis of the spinal canal or dysphagia, thus seems to be a finding without clinical relevance.

KEY WORDS: Spine, Radiographs, Pain, Osteoarthritis, Forestier's disease, Ankylosing vertebral hyperostosis


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