Trinity Medical Center I Dr. Marin Guentchev, MD, PhD

Diffuse idiopathic skeletal hyperostosis


The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid. The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus). The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.


Diffuse idiopathic skeletal hyperostosis (Forestier's disease) is a calcification (bony transformation) of ligaments of the spine and in rare cases of the shoulders, elbows, knees and heels. It can affect all compartments of the spine. Diffuse idiopathic skeletal hyperostosis may worsen over time and in in some cases can cause serious complications.


The formation of osteophytes and fusion of individual vertebrae.


Stiffness in the neck/back
Difficulty swallowing


Medical history Clinical exam
and at least one of the following tests:
Computer tomography Radiographs


Treatment is usually non-surgical.
Non-surgical treatment may include
Physiotherapy Nonsteroidal anti-inflammatory drugs

The condition is treated by medical spetialists in the field of:

Trinity Medical Center
117 Zaichar St /Ground floor/
/Konstantin Velichkov Metro Station/
BG-1309 Sofia, Bulgaria
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