Correspondence

Anterior Cervical Osteophytes

N Engl J Med 2004; 350:1688April 15, 2004

Article

To the Editor:

One of the images presented by Aronowitz and Cobarrubias (Dec. 25 issue)1 is described as showing a “huge mantle of osteophytic bone anterior to the spine from C2 to C7.” The term “osteophyte,” however, is controversial when used in relation to the nonsynovial discs of the spine. More important, the images are of a specific entity with a widespread ossifying diathesis. This condition was originally described in the spine by Forestier and Rotes-Querol2 in 1950 and became known as Forestier's disease. A landmark article by Resnick and colleagues3 in 1975 popularized the more descriptive term “diffuse idiopathic skeletal hyperostosis” (DISH), and it was subsequently the subject of a Case Records article published in the Journal.4 DISH is probably an extreme example of the normal aging process involving calcifications and ossifications at the osseous attachments of tendons and ligaments (entheses), commonly referred to as “enthesopathy.” As in the case described by Aronowitz and Cobarrubias,1 it is commonly seen in elderly men.

Ferris M. Hall, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215
fhall@bidmc.harvard.edu

4 References

1. 1

   Aronowitz P, Cobarrubias F. Anterior cervical osteophytes causing airway compromise. N Engl J Med 2003;349:2540-2540
   Full Text | Web of Science | Medline

2. 2

   Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 1950;9:321-330
   CrossRef | Web of Science | Medline

3. 3

   Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations. Radiology 1975;115:513-524
   Web of Science | Medline

4. 4

   Case Records of the Massachusetts General Hospital (Case 43-1989). N Engl J Med 1989;321:1178-1187
   Full Text | Web of Science | Medline

Author/Editor Response

We chose to describe the images rather than draw conclusions about a disease entity that they may represent. Strictly speaking, an osteophyte is an osseous outgrowth. The images that we present do, in fact, show a huge mantle of osteophytic bone. Dr. Hall is correct in pointing out that the images probably reveal the presence of DISH, sometimes known as Forestier's disease.

Paul Aronowitz, M.D.
California Pacific Medical Center, San Francisco, CA 94941