A Man With Stooped Posture and Mysterious Back and Neck Pain

Nirupam Prakash, MD, MBBS

Disclosures

November 19, 2020

The diagnosis of DISH often happens late in the course of the disease, when ossification of the spinal ligament is advanced or compression of adjacent structures by large osteophytes has already occurred. Analgesic anti-inflammatory agents have been found to produce symptomatic relief and reduce accompanying inflammation. Similarly, muscle relaxants may serve to reduce stiffness.

Large osteophytes may produce radicular or cord compression and may be complicated by osteophytic fractures. Large osteophytic spurs in the cervical spine may be a cause of difficult intubation, failed endoscopic procedures, and dysphagia, and they may require surgical correction[9]; therefore, DISH should be considered in high-risk individuals presenting with backache and stiffness, such as those with diabetes, hypertension, or atherosclerotic vascular disease.[9] DISH must be differentiated clinically and radiologically from osteoarthritis and ankylosing spondylitis.

Various treatment options can be considered for DISH, including tighter control of possible underlying causative diseases, such as hypertension and dyslipidemia. However, a paucity of evidence is available to show that any established treatment alters the natural progression of DISH.

The management of the patient in this case included weight control, lifestyle modification, maintenance of euglycemia, blood pressure control, and normalization of serum lipid levels. Atorvastatin was begun (20 mg once daily), as was naproxen (250 mg twice daily). He was advised to engage in regular aerobic exercises and specific flexibility exercises to increase his spinal mobility. His 3-month checkup revealed an LDL level of 98 mg/dL, symptomatic improvement, and a self-reported increase in spine mobility.

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