Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition involving the enthesis which is loaded with collagen fibers, fibroblasts and other mesenchymal cells, fibrocartilage, and calcified matrix that penetrate the bone cortex at its attachment.

Some classify the condition requiring two or more segments for the diagnosis.

At ddd, we use real specimens to inspire new innovation.  This latest addition to our growing spine collection warranted a teaching moment to those that treat DISH.  If you look closely, the joint space width and pristine nature of the facets indicates that hyperostosis on the anterior aspect of the vertebral bodies naturally act as a perfect balance between motion and immobility.  Just the right amount of spinal stability appears to have yielded the perfect situation for the facets.

cervical spine imaging using upright MRI

Dynamic cervical spine upright imaging can play a significant clinical role is identifying pain generators.

Here is a case whereby the patient would complain of headaches associated with being upright during the day. The patient wondered why exercise helped but being in one spot, like working on a computer, caused headaches.  Can you see why?

Explore our roster of cervical models in the identification of pain generators of headaches.

Lumbar Disc Herniation Model - fibrous annulus model

Annulus Fissures are Mechanically and Chemically Conducive to the Ingrowth of Nerves and Blood Vessels

Our quest  to explain spinal pain generators has yet again found the ingrowth of nerves into the annulus a significant contributor. This research builds on Freemont’s fundamental work in the Lancet.  Read here!

midsagittal bulge

Running and disc height loss occurs with moderate intensity after 30 minutes.

Many people complain about spinal related pain in and around the act of running.  Here is a wonderful article from Medicine and Science in Sports and Exercise. Running is a form of spinal compression but it is also a form of decompression.

These researchers found that the net result of 30 minutes of moderate running caused significant disc height loss in the spine. They found the discs lost about 6% of their height which can be quite substantial if the discs are already compressed.

R&D - Dynamic Disc Designs

I was just asked to provide a testimonial for our first and only, to date, upright MRI clinic in Canada.  And in writing it, thought I would provide a quick note on its value to me as a practitioner.

Very often, pain presents in a loaded state.  That is, most of our patients complain of pain while sitting, after sitting, after standing, after bending, after lifting….etc.. you get the point.  And it would hard pressed to find someone that disagrees with this.  So, then, why are we imaging these patients while recumbent often when their pain is diminished to absent?  Upright MRI allows a look into the dynamic nature of the intervertebral discs.  And with the disc being the most popular pain generator for low back pain, why don’t we image the disc under load more frequently?  Personally, I have used upright MRI to see the disc bulge even more in extension and reveal many spondylolistheses that are otherwise unrecognized.  We do know in extension the disc will bulge more into the spinal canal and that is something that has been seen clearly.  We also see this canal narrow as the ligamentum flavum folds anteriorly.  (see the review of : Upright positional MRI of the lumbar spine Figure 1).  This makes perfect sense why those stenotic patients, for example, find more relief with sitting.  But what research cannot show, yet, is the innervation patterns in the annulus and the nucleus as it pushes through  these tears under flexion.

Jerome Fryer - ddd models

ddd models can connect your knowledge of pain generators to a patient’s understanding.  When there is understanding there is often better awareness and avoidance of aggravating spinal motions to help improve outcomes.  I hope we continue to push in research directions to give us better tools to identify the pain generators and what to do about it clinically. Our patients deserve the best. JF

Modeling by Dynamic Disc Designs Corp.

The impetus behind the innovation of began dynamic models in the late 90’s but the fire that fueled the completion started in 2006.

This was amidst many projects including building a new practice and the writing of three research papers. My goal is quite simple and I hope to explain this through these blog posts.

Can we improve the diagnosis and treatment of spine and can we better treatment outcomes? Of course. JF