INTRODUCTION:
Diffuse idiopathic skeletal hyperostosis (DISH) is an ossification of the vertebral body's anterior and lateral side (1,2). This is a rare entity and also known as Forestier’s disease, rarely associated with systemic diseases such as diabetes mellitus and obesity and occurs mostly in the fifth and sixth decade of life and in males (3). The osteophytes are usually seen in the thoracic, lumbar and cervical vertebrae (97%, 90%, 78%) (4). Most of patients are asymptomatic, dysphagia is the most common symptom due to compression of esophageus by anterior osteophytes at the level of C4-5. Cervical subaxial pain, stiffness and decreasing range of motion of the cervical spine are the other complains (5). This, reports a case of a 72 years man having the DISH syndrome who suffering from type 2 diabetes.
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He was fall down due to a traffic accident while standing in a bus. His had type II diabetes that treated with oral agents. On physical examination, GCS score was 15, pulse rate was 74/min, BP was 176/86 mmHg and SpO2 was 100%. There was a mild tenderness on palpation of cervical vertebras. His abdomen, respiratory system and cardiovascular system were normal. There was no focal neurological deficit on central nervous system examination. All laboratory tests were normal. Cervical computed tomography (CT) revealed bony ankylosis from C2 to C7. And there was a suspected fracture on C3 (Fig. 1). Axial images showed large bridging syndesmophytes at C3 to C7 level. Sagittal multiplanar reconstruction images also showed this indentation (Fig. 2). The patient was referred to the neurosurgery clinic, and they offered out-patient follow up with a soft cervical coller. The patient treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for