Can DISH disease kill you? (+3 reasons)

In this article, we will discuss whether diffuse idiopathic skeletal hyperostosis (DISH) disease may kill you. We will also discuss complications of DISH disease which may prove fatal.

Can DISH disease kill you?

No, diffuse idiopathic skeletal hyperostosis (DISH) disease itself may not kill you. However, other associated complications can reduce your life expectancy and cause death. If left untreated, symptoms associated with DISH disease may worsen over time.

You may live a normal life if you strictly follow the directions of your doctor for the management of DISH disease. DISH disease is a noninflammatory disease that involves calcification and ossification of soft tissues (1).

The bone compression of the adjacent structures may cause gastrointestinal, respiratory, and neurological complications that may reduce the quality of life (2). You should consult your doctor immediately if you experience such complications.

Complications of DISH disease which may prove fatal

Some of the complications of DISH disease which may prove fatal include:

Respiratory depression

The compression of the trachea by the anterior longitudinal ligament (ALL) may cause respiratory depression and laboured breathing (dyspnea). Serious respiratory depression may cause hypoxic brain injury which may prove fatal if not managed immediately (3).

Acute dyspnea is often a medical emergency and requires rapid medical interventions. The patient needs to be placed on supplemental oxygen and a cardiac monitor. If not treated properly, it may cause death due to respiratory failure (4).

Spinal fractures

Research suggests that an ankylosed spine is prone to injury even after a minor trauma. The patients may get fractures in the cervical spine after low-energy impacts. The average mortality rate after three months of injuries is 20% in patients with DISH disease (5).


According to a research study, the incidence of stroke and cerebrovascular diseases was higher in patients (n=45) diagnosed with DISH. DISH disease can increase the incidence of major cerebral artery occlusion and infarction, leading to stroke (6).

Aspiration pneumonia

In rare cases, DISH may cause aspiration pneumonia. One of the common complications of DISH is dysphagia (difficulty in swallowing). Large osteophytes due to DISH may cause aspiration events during the swallowing phase.

This may lead to airway obstruction, infection, and severe obstruction of the oesophagus (7). The mortality rate due to aspiration pneumonia is more prevalent in the elderly, especially due to pulmonary and neurological disorders (8).

What are the symptoms of DISH disease?

DISH disease may remain asymptomatic for a long time before proper diagnosis. Some of the common symptoms associated with DISH disease involve (9):

  • Morning stiffness,
  • Spinal pain,
  • Pain in the shoulders, heel, and knees,
  • Reduced range of motion,
  • Soft tissue tenderness, and
  • Vertebral fractures.

Some of the severe complications that may occur DISH disease include:

  • Myelopathy,
  • Dysphagia,
  • Regurgitation,
  • A feeling of foreign matter in the throat,
  • Sleep apnea,
  • Thoracic outlet syndrome,
  • Hoarness, and 
  • Oesophageal obstruction.

How to manage DISH disease and associated complications?

DISH disease cannot be cured, however, some clinical interventions may reduce the symptoms. 

Intervention Reason
Exercise and physical therapy To improve range of motion, back pain, and stiffness
Heat pads To reduce morning stiffness
Blood sugar control Reduce the severity of DISH disease
Control weight Reduce the severity of DISH disease
Orthotics Ease in walking
Pain relievers Acetaminophen and Iburporfen
Surgery Anterior cervical osteophytectomy for dysphagia(10)

For the complications caused by DISH disease, the following emergency interventions might lessen the severity of the disease and improve the chances of survival:

Complication Emergency treatment
Respiratory depression Supplemental oxygen, oxygen therapy, and respiratory stimulant medications (4)
Spinal fractures Surgery to realign the bones (5)
Stroke Tissue plasminogen activators (6)
Aspiration pneumonia Maintenance of airways and antibiotics (8)

Some of the antibiotics used for aspiration pneumonia include ampicillin-sulbactam or a combination of metronidazole and amoxicillin. Your doctor may also use albuterol sulphate to clear airway obstruction and improve breathing by loosening the mucus.

In my experience

In my experience as a healthcare professional, DISH disease may not kill you. However, other complications associated with DISH disease may decrease your quality of life and prove fatal.

You should follow the directions of your doctor to reduce the symptoms of DISH disease, adopt a healthy life, and exercise daily to keep your muscles working. You may take pain relievers to reduce muscle stiffness after consulting your doctor.

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Vengust R, Mihalič R, Turel M. Two different causes of acute respiratory failure in a patient with diffuse idiopathic skeletal hyperostosis and ankylosed cervical spine. European Spine Journal. 2010 Jul;19:130-4.


Ballantyne JC, Scott TH. Complications associated with systemic opioids and patient-controlled analgesia. Complications in Regional Anesthesia and Pain Medicine. 2012 Jul 18:207.


Hashmi MF, Modi P, Basit H, et al. Dyspnea. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.


Westerveld L, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. European Spine Journal. 2009 Feb;18:145-56.


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Lee JJ, Hong JY, Jung JH, Yang JH, Sohn JY. Recurrent aspiration pneumonia due to anterior cervical osteophyte. Korean Journal of Critical Care Medicine. 2017 Feb 28;32(1):74-8.


Gupte T, Knack A, Cramer JD. Mortality from aspiration pneumonia: incidence, trends, and risk factors. Dysphagia. 2022 Dec;37(6):1493-500.


Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nature Reviews Rheumatology. 2013 Dec;9(12):741-50.


Jonathan YL, Sayal P, Prezerakos G, Russo V, Choi D, Casey AT. The surgical management of dysphagia secondary to diffuse idiopathic skeletal hyperostosis. Clinical Neurology and Neurosurgery. 2018 Apr 1;167:36-42.