Volume 127, Issue 3, June 2010, Pages 111-116 https://doi.org/10.1016/j.anorl.2010.05.002Get rights and content Diffuse idiopathic skeletal hyperostosis (DISH)
ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS
In spite of their name, bone spurs are smooth, bony growths that form over a long period of time. They are a growth of normal bone that tends to occur as we age. The spurs themselves are not painful. Their effect on nearby structures, such as nerves and the spinal cord, can cause pain. The spine is made up of 33 bones (vertebrae) designed to protect the spinal cord. Gel-filled discs between the bones serve as shock absorbers. The discs also allow us to bend forward and backward and twist our backs in a variety of directions. Behind each disc and under each joint are openings that allow a part of nerve roots to leave the spinal cord to go to other parts of the body. These tiny openings, called foramen, enclose the nerve and are just large enough for the nerve to go through. Bone spurs, also known as osteophytes, can be a problem if they develop in the openings for the nerve roots. They make the space narrower and press on the nerve. This is called foramen stenosis.
A variety of factors contribute to bone spurs. These include:
In addition, certain conditions can make it more likely that bone spurs will develop, including:
In persons 60 and older, bone spurs are common. A little more than 40 percent of the population will develop symptoms that require medical treatment as a result of bone spurs.
Back or neck pain is the most common sign of bone spurs. The joint becomes inflamed (swollen and tender) and the back muscles become tender. Common symptoms are:
Activity tends to make the pain worse. Rest tends to make it better. If the symptoms affect the back, the person may feel better leaning forward and bent at the waist as in leaning over a shopping cart or cane. If there is severe pressure on the nerves, a person may have problems controlling his or her bladder or bowels.
After taking the patient's medical history and performing a physical examination, physicians can rule out conditions that may have similar symptoms but different causes. Tests that a doctor may order include:
Several approaches can be taken to treatment depending on the severity of the symptoms. A conservative approach for persons with mild or moderate pressure on the nerves or spinal cord might include:
If this approach isn't successful, surgery may be needed, such as a laminectomy to remove bone spurs. Key points
Tips to help you get the most from a visit to your healthcare provider:
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