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Diffuse Idiopathic Skeletal Hyperostosis

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The clinical, radiographic, and pathologic features of diffuse idiopathic skeletal hyperostosis (DISH) distinguish it from ankylosing spondylitis, spondylitic variants, acromegaly, hypoparathyroidism, hypervitaminosis A, Ochronosis, and fluorosis. Although there is a general tendency to attribute the peculiar pattern of spinal abnormality in DISH to “degenerative” or “discogenic” alterations, this is misleading. DISH differs considerably from intervertebral (osteo)chondrosis, which is the typical degenerative disease of the nucleus pulposus. DISH most resembles spondylosis deformans, although both qualitative and quantitative differences exist between the two entities. Spondylosis deformans is associated with spinal osteophytosis, and the pathogenesis of these outgrowths probably relates to changes in the anulus fibrosus. Disc protrusion followed by traction osteophytes appears to be the sequence of events in spondylosis deformans. These findings are identical to those occurring as part of the spinal abnormalities of DISH (type II). Spinal ligament calcification and ossification occur in DISH but are not a prominent feature of spondylosis deformans, and an enthesopathy is observed where the anterior longitudinal ligament attaches to the periosteal surface of the vertebral body. These findings could represent true qualitative differences between the two disorders. DISH may represent an ossifying diathesis that causes excessive bone formation at skeletal sites subject to normal or abnormal stress. These sites are generally found at points of tendon and ligament attachment to bone, in both the axial and extra-axial skeletons.
The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format.
This will be an official peer-reviewed publication.
The publication will be a favorable addition to the candidate's CV.
The candidate will be the first author, and I am the second author.
A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about)
The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
Dennis K. Bielecki, MD
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