Klippel Feil syndrome
Diffuse idiopathic skeletal hyperostosis (DISH), also referred to as Forestier disease, is a common condition characterized by bony proliferation at sites of tendinous and ligamentous insertion of the spine affecting elderly individuals.
On imaging, it is typically characterized by the flowing ossification of the anterior longitudinal ligament involving the thoracic spine and enthesopathy (e.g. at the iliac crest, ischial tuberosities, and greater trochanters). There is no involvement of the sacroiliac synovial joints.
Radiographic features: Plain radiograph and CT
- flowing ossifications: florid, flowing ossification along with the anterior or right 7 anterolateral aspects of at least four contiguous vertebrae
- Disc spaces are usually well preserved
- Ankylosis is more common in the thoracic than cervical or lumbar spine
- frequently incomplete
- can have interdigitating areas of protruding disc material in the flowing ossifications
- no sacroiliitis or facet joint ankylosis
- enthesopathy of the iliac crest, ischial tuberosities, and greater trochanters
- spur formation in the appendicular skeleton (olecranon, calcaneum, patellar ligament) frequently present ‘whiskering’ enthesophytes