Conservative Treatment of Low Back Pain with Incidental Finding of Diffuse Idiopathic Skeletal Hyperostosis: A Case Report

Low back pain affects 630 million people worldwide and may result in a physical, social, or psychological liability to those people [1]. Patients with lower back pain commonly will have a higher incidence of functional disability, psychosocial issues, and decreased work productivity [1]. The clinician muscle must provide the correct course of treatment for the patient, clinician [2]. Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory condition resulting from a pathologic calcification and ossification of areas of the spine and possibly other joints [3]. Several risk factors in developing DISH are advanced age, hypertension, diabetes, obesity, and genetics [4,5]. Individuals with DISH are typically asymptomatic; however, a study of two hundred individuals diagnosed with DISH demonstrated that 72% were experiencing back pain and 84% reported overall spinal stiffness [3,4]. Diffuse idiopathic skeletal hyperostosis is an incidental finding in imaging in which the pathogenesis is currently not known [3,4]. To diagnose DISH in the spine it is required to observe at least three bony bridges at the anterolateral spine [4]. The bony bridges are viewed as osteophytes on the anterior portion of the spine [3]. DISH in the cervical spine may lead to symptoms such as dysphagia or upper airway obstruction [3]. Additionally, in the spine DISH has been linked to compression of neural structures resulting in myeloradiculopathy [3]. Structurally, this can lead to spinal stenosis, and spinal cord or nerve root compression [3].Currently, there is one published article describing chiropractic treatment of DISH with flexion distraction technique [6]. Al-Herz et al. [7] discussed exercise therapy for patients with DISH. Additionally, Le et al. [3] discussed, briefly, several strategies for the management of DISH. Current literature does not combine instrument-assisted manipulation, soft tissue therapy, and exercise therapy for the management of DISH. Therefore the purpose of this article is to demonstrate the effectiveness of exercise and manual therapy for the treatment of DISH related pain and dysfunction.