Asymptomatic course of Forestier's disease (clinical case)

Abstract

Diffuse idiopathic skeletal hyperostosis, or Forestier's disease, is a rare disease of the musculoskeletal system, leading to calcification of ligaments and tendons and, as a consequence, to ankylosing due to bone proliferation in the places of the tendon and ligamentous apparatus of the spine. As radiation imaging shows, the disease features are uniform ossification of anterior longitudinal ligament, mainly of thoracic spine, as well as damage to entheses. The disease may be detected accidentally and not manifest itself for many years, or it may be asymptomatic. In some cases, Forestier's disease can be characterized by pain in the back, limited movement in the spine. The development theory of Forestier's disease, leading to calcification, is based on an excessive number of growth factors, such as insulin-like growth factor 1, insulin, transforming growth factor beta 1, prostaglandins I2 and endothelin 1, platelet growth factor, leading to the transformation of mesenchymal cells into fibroblasts and osteoblasts. There is an opinion that the lesion of the left longitudinal ligament occurs extremely rarely, unlike the right one, since due to the pulsation of the descending aorta there is a so-called protective effect and a mechanical barrier. A described clinical case is an accidental radiological finding.