CTICasesThoracic Spine Fracture through a Disc Space in Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Imaging findings
An elderly man fell from standing and was found on radiograph and sagittal CT to have an unusual fracture crossing a thoracic disc space, extending from the ossified anterior longitudinal ligament through the disc into the vertebral body, across the disc space, and into the level below. The spine showed diffuse idiopathic skeletal hyperostosis (DISH), with a broken, flowing anterior osteophyte and a visible step-off marking the fracture site.
Key takeaways
Patients with DISH have a rigid spine that is prone to unstable, transdiscal fractures even from low-energy trauma such as a standing fall, because the normal flexibility of the spine is lost and force is transmitted through fixed segments rather than absorbed; a broken flowing osteophyte with a step-off is a key clue to an otherwise subtle fracture in this population, who are often also osteopenic and at further increased fracture risk.
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