# Diffuse Idiopathic Skeletal Hyperostosis of Upper Cervical Vertebrae: A Case Report of a Rare Anatomical Presentation During Bone Retrieval

## TL;DR

A rare case of bone overgrowth in the upper neck spine was found during a dissection, highlighting its potential health risks.

## Contribution

This case report documents a rare anatomical presentation of DISH in the upper cervical vertebrae.

## Key findings

- Ossification of the anterior longitudinal ligament and alar ligament was observed in the upper cervical vertebrae.
- Upper cervical DISH can cause symptoms like dysphagia and airway obstruction.
- The condition may appear incidentally but requires clinical attention due to proximity to vital structures.

## Abstract

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a systemic skeletal disorder characterized by ossification of spinal and extraspinal ligaments. While DISH commonly affects the thoracic and lumbar spine, upper cervical involvement (C1-C3) is rare. During routine dissection and subsequent bone retrieval for the osteology library at Goa Medical College, ossification of the anterior longitudinal ligament (ALL) and the alar ligament was observed in the upper cervical vertebrae. Upper cervical DISH may remain asymptomatic or manifest as dysphagia, airway obstruction, and restricted neck movement. Radiological features include the characteristic “dripping candle wax” appearance. Diagnosis is based on Resnick’s criteria. Although often incidental, upper cervical DISH has significant clinical implications due to its proximity to vital structures such as the esophagus and trachea. Awareness of this rare presentation is crucial for timely diagnosis and management.