Spine: diffuse idiopathic skeletal hyperostosis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: diffuse idiopathic skeletal hyperostosis

Sample item

A 65-year-old obese diabetic man has a stiff thoracic spine. Radiographs show flowing ossification along the anterior right side of at least four contiguous vertebrae, with preserved disc height and normal sacroiliac joints. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Diffuse idiopathic skeletal hyperostosis (Forestier disease)

Diffuse idiopathic skeletal hyperostosis, or Forestier disease, shows flowing anterior ossification of four or more contiguous vertebrae, with preserved disc spaces and no sacroiliac erosion. It is common in older men with diabetes and obesity. It causes stiffness and dysphagia from cervical osteophytes, and the spine is brittle in injury.

Option by option

  • A. Degenerative disc disease

    Degenerative disc disease causes disc space narrowing and osteophytes without flowing ossification.

  • B. Ankylosing spondylitis

    Ankylosing spondylitis starts in the sacroiliac joints with thin syndesmophytes.

  • C. Diffuse idiopathic skeletal hyperostosis (Forestier disease) (correct)

    Correct. Flowing ossification with preserved discs and normal sacroiliac joints is DISH.

  • D. Spinal tuberculosis

    Spinal tuberculosis destroys disc spaces and vertebrae.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Diffuse idiopathic skeletal hyperostosis (Forestier disease). Diffuse idiopathic skeletal hyperostosis, or Forestier disease, shows flowing anterior ossification of four or more contiguous vertebrae, with preserved disc spaces and no sacroiliac erosion.

Why is "Degenerative disc disease" not the answer?

Degenerative disc disease causes disc space narrowing and osteophytes without flowing ossification.

Why is "Ankylosing spondylitis" not the answer?

Ankylosing spondylitis starts in the sacroiliac joints with thin syndesmophytes.

Why is "Spinal tuberculosis" not the answer?

Spinal tuberculosis destroys disc spaces and vertebrae.

What concept does this question test?

It tests Spine: diffuse idiopathic skeletal hyperostosis in Orthopaedics. It is common in older men with diabetes and obesity. It causes stiffness and dysphagia from cervical osteophytes, and the spine is brittle in injury.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: diffuse idiopathic skeletal hyperostosis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.