An X ray of the spine showing at least four adjacent vertebrae joined by newly formed bone is essential for the diagnosis. other conditions that can cause similar appearances should be excluded. These are particularly ankylosing spondylitis and degenerative disc disease (see back pain). The X-ray changes in DISH are usually quite distinctive, with the extra bone growth appearing to flow from vertebrae to vertebrae like candle wax, affect mainly the right side of the spine and lacking severe changes in the disc or any damage to the vertebral body.
Treatment and Outcome Most people with DISH do not have symptoms and do not need any treatment. Those with spinal stiffness need to understand what the problem is and use occasional painkillers as needed. A very few may need surgical removal of a spur or decompression of the spine or nerve root. injection of a small amount of corticosteroids around a painful heel spur may be very helpful. Those who are overweight should lose weight and exercise more, but it has not been shown that this will beneficially affect the DISH. More importantly, in these patients the diagnosis of DISH may prove the trigger for them and their physician to recognize that they have the metabolic syndrome. These patients often have high insulin levels, insulin resistance, obesity, hypertension, gout, and high lipid levels as well as a high risk of coronary artery disease.
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