"DISHphagia" - AN UNUSUAL CAUSE OF DYSPHAGIA IN A PATIENT WITH DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS: A CASE REPORT AND LITERATURE REVIEW

Background: Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory, chronic, systemic disorder characterized by ossification of entheses, primarily affecting the spine. DISH is mostly asymptomatic but can manifest with chronic pain, limitation of spinal mobility, and rarely dysphagia. Aim: Our aim is to highlight the significance of DISH and its prevalence in the general population, as well as to raise awareness among clinicians of its role in the differential diagnosis of dysphagia, given that few similar cases have been reported and that surgical management is associated with a good prognosis. Description of the case: A 66-year-old male was admitted to the Department of Neurosurgery with a nine-year history of dysphagia and neck stiffness, which worsened over the preceding two years. CT and MRI scans revealed diffuse calcification of the anterior spinal ligament consistent with a diagnosis of DISH. The patient underwent surgical removal of osteophytes at the C4–C5–C6 levels. Postoperatively, the patient showed no neurological deficits, with only mild intermittent swallowing difficulties that considerably improved. Conclusions: DISH should be considered in the differential diagnosis of chronic dysphagia in elderly patients, particularly when associated with cervical pain or reduced neck mobility. Surgical removal of osteophytes may provide substantial symptomatic relief in selected patients with severe or progressive symptoms. Increased awareness of this uncommon presentation may facilitate earlier diagnosis and treatment.