Forestier's Disease

Demographic and clinical details: 48 years old female, admitted with neck pain

Image Details; Lateral cervical X ray (a) shows the flowing ossification along the anterior aspect of cervical spine extending from C4 through C7(white arrows). Sagittal T1 and T2W images shows the marked heterogeneous thickening of the anterior longitudinal ligament along the anterior aspect of cervical spine (white arrows). Posterior longitudinal ligament thickening (red arrow) is also seen on MR images (b, c). Note the preservation of disc spaces and facet joints, consistent with DISH (Diffuse Idiopathic Skeletal Hyperostosis- Forestier's disease).

 Forestier's disease which is characterized by calcification and ossification of ligaments and entheses , generally affects axial skeleton. DISH is an entesopathy, can be mistaken for Seronegative spondyloarthropathies. It is also known as Ankylosing spondylitis of elderly.  Ossification of anterior longitudinal ligament with or without osteophytes is the primary pathology in DISH like in our case. In some cases ossification of posterior longitudinal ligament can be seen also. Involvement of four contiguous vertebral bodies is important for diagnosis.

In my experience, lateral radiography is important for diagnosis of Forestier's disease. İnvolvement of 4 contigious vertebral level, preservation of disc spaces and facet joints should remind the diagnosis of Forestier's disease.