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Robert Borzone


Diffuse Idiopathic Skeletal Hyperostosis, Diagnostic imagine, Chiropractic


Objective: To describe the diagnosis and treatment of a patient with low back, left hip and groin pain and numbness of the left anterior thigh.

Clinical Features: A 69-year-old male, complained of very sharp pain radiating from his lower spine to his left hip and vertically from his left hip to the pubic bone. Anterior/lateral thigh numbness was also present. He was symptomatic for 6 months and his pain became severe 1 week prior to his office visit. He stated that he had suffered a traumatic injury to his back when he was 14 years old and that his back had never been the same. He had pain when rising from sitting as well as bending forward and his condition was inhibiting his ability to maintain his organic garden (bending, lifting, carrying, shoveling, etc.) He denied taking any medication for his condition.

Intervention and Outcome:  A diagnosis of diffuse idiopathic skeletal hyperostosis (DISH, Forestier’s Disease) was made after examination and diagnostic imaging. Treatment included Coxâ Flexion Distraction spinal manipulation of the lumbar spine to treat his hip, groin and anterior thigh pain. At the onset of treatment, he rated his pain as 10/10 on a 0-10 numeric pain scale rating. After 4 treatments, he had no thigh or hip pain, only low back and groin pain. After 14 treatments, he stated that he was pain-free. Nutritional support with chondroitin sulfate and hyaluronic acid was given. Spine and hip stretching exercises were prescribed. Two return bouts of exacerbation of his left thigh numbness, which he attributed to too much gardening work, resulted in continued manipulation treatment.

Conclusion: Treatment of DISH of the thoraco-lumbar and lumbar spine with distraction spinal manipulation resulted in relief of low back, hip and groin pain and reduction of left anterior thigh pain.


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