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Fig. 6 Cervical spinal
stenosis with spinal cord
compression by magnetic
resonance imaging. Sagittal
view of a cervical spine, T2
weighted images. At the
C4
-
C5 level, intervertebral
disk bulge compresses the
spinal cord, associated with
hyperintense signal at the
corresponding level (arrow),
indicating structural damage
of the spinal cord. Asterisks
mark intervertebral disks
usually intact in DISH. Lack of sacroiliac joint involvement and in
ammation
distinguishes DISH from ankylosing spondylitis [
33
,
34
]. The cause of DISH
remains unclear.
DISH is rare in people younger than 40 years old. It generally affects people
older than 50, with a prevalence of 15 % in women and 25 % in men. This
prevalence increases to 26
fl
-
28 % in those over 80 years [
35
].
2.4.2 Clinical Manifestation
DISH is largely asymptomatic. Patients may report pain in the spine and legs,
morning stiffness, and limited spine
flexibility. Pain in the upper back is common,
and is often associated with limited chest expansion. The cervical spine and lumbar
spine may also be involved. Although rare, in severe cases, large calci
fl
cations may
impinge on the airway to cause dif
culty or pain with swallowing, hoarseness, or
high-pitched sounds from the throat with breathing. In the peripheral joints, cal-
ci
cation of the ligaments and entheses (sites where tendon attach to the bone)
cause local pain, and can limit movement of the affected joints. Some patients have
tenderness and nodules of the entheses.
