Fact-sheet: Diffuse idiopathic skeletal hyperostosis - Forestier disease
Updated on 02/17/2022 at 4:00 PM
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Definition
Disease of unknown etiology affecting the musculoskeletal system, mainly the axial skeleton, particularly the thoracic spine. Cervical involvement in
75% of cases.
Progressive ossification of the periosteum, ligaments, and tendons.
Affects:
- 2 men to 1 woman
- 25% of autopsies performed after age 50.
Genetic role: autosomal dominant inheritance of the disease sometimes found.
Clinical features
Mild
Second leading cause of cervical myelopathy
Main extravertebral involvement: Shoulders, elbows
Frequent periarticular ossification after hip replacement.
Painless stiffness and hypertrophic vertebral ossification should raise suspicion
Dysphagia
Classic transverse cervical fracture, from minor trauma
Radiography
- Anterior intervertebral bony bridges, predominating on the right at the thoracic level, coarse, spanning more than 4 consecutive levels
- No evidence supporting spondyloarthropathy, normal sacroiliac joints
- Intervertebral disc space height preserved, unlike osteoarthritis
- Broader base of attachment to the vertebral body than osteophytes of osteoarthritis
CT
- Anterior intervertebral bony bridges, predominating on the right at the thoracic level, coarse, spanning more than 4 consecutive levels
- No evidence supporting spondyloarthropathy, normal sacroiliac joints
- Intervertebral disc space height preserved, unlike osteoarthritis
- Broader base of attachment to the vertebral body than osteophytes of osteoarthritis
MRI
Similar semiology on CT.
No evidence supporting axial spondyloarthritis.
Management
No preventive or curative drug treatment.
Physical therapy may improve patient mobility.
Surgery may be considered in cases of myelopathy or dysphagia
Differential diagnosis
- Osteoarthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Fiessinger-Leroy-Reiter syndrome