The association between cervical diffuse idiopathic skeletal hyperostosis and dysphagia

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is increasingly recognized as a structural cause of dysphagia due to anterior cervical osteophyte formation, yet its clinical risk factors, severity determinants, and laterality patterns remain poorly understood. This study aims to investigate the associations between cervical DISH presence, severity, and laterality with clinical, metabolic, and nutritional factors in patients presenting with dysphagia. This was a retrospective observational study including 208 dysphagia patients who underwent head and neck CT imaging between 2014 and 2023. DISH was diagnosed using the Resnick criteria, and severity was classified based on osteophyte thickness (< 3 mm = mild, 3-7 mm = moderate, > 7 mm = severe). Laterality was categorized as midline, right-sided, left-sided, or bilateral. Clinical, metabolic, and nutritional variables were compared between DISH and non-DISH groups using t-tests, Chi-square tests, and logistic regression models. Multivariate analyses were performed to identify independent predictors of DISH presence and severity. DISH was present in 81 patients (38.9%), who were significantly older than non-DISH patients (75.2 ± 11.5 vs. 68.3 ± 20.9 years, p = 0.007). Low serum albumin (< 3.5 g/dL) was significantly associated with DISH presence (p = 0.013) and severe DISH cases (p = 0.067). Multivariate analysis identified low serum albumin (aOR = 2.665, p = 0.019) and drug use (aOR = 2.015, p = 0.040) as independent predictors of DISH. Midline involvement was the most common laterality pattern (54.3%), with Parkinson's disease significantly associated with midline DISH (p = 0.005). Patients with bilateral DISH had the highest prevalence of low serum albumin (100%, p = 0.029). DISH is an underrecognized yet clinically significant contributor to dysphagia, with low serum albumin levels, COPD, and chronic pain as key predictors of its presence. Severe DISH is strongly associated with low serum albumin levels, which may reflect nutritional compromise or systemic disease processes. Midline DISH predominates, particularly in Parkinson's disease, while bilateral involvement correlates with poor nutritional status. These findings provide critical insights for early identification, targeted management, and surgical decision-making in patients with dysphagia and DISH.

Keywords: DISH; Diffuse idiopathic skeletal hyperostosis; Dysphagia; Regression.