Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Jul 9;15(1):24613.
doi: 10.1038/s41598-025-08937-9.

The association between cervical diffuse idiopathic skeletal hyperostosis and dysphagia

Affiliations
Observational Study

The association between cervical diffuse idiopathic skeletal hyperostosis and dysphagia

Alaa Safia et al. Sci Rep. .

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.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

References

    1. Rajati, F., Ahmadi, N., Naghibzadeh, Z. A. S. & Kazeminia, M. The global prevalence of oropharyngeal dysphagia in different populations: a systematic review and meta-analysis. J. Translational Med.20, 175 (2022). - PMC - PubMed
    1. Carucci, L. R. & Turner, M. A. Dysphagia revisited: common and unusual causes. Radiographics35, 105–122 (2015). - PubMed
    1. Jonathan, Y. L. et al. The surgical management of dysphagia secondary to diffuse idiopathic skeletal hyperostosis. Clin. Neurol. Neurosurg.167, 36–42 (2018). - PubMed
    1. Nascimento, F. A. et al. Diffuse idiopathic skeletal hyperostosis: A review. Surg. Neurol. Int.5, S122 (2014). - PMC - PubMed
    1. Mader, R. et al. Diffuse idiopathic skeletal hyperostosis (DISH) and a possible inflammatory component. Curr. Rheumatol. Rep.23, 1–6 (2021). - PubMed

Publication types

LinkOut - more resources