Forestier’s disease with complete spinal involvement

A 70-year-old diabetic and hypertensive male patient visited our clinic with complaints of non-inflammatory back pain since two years. He was heavy built with a BMI of 29 kg/m2. Physical examination revealed limitation of flexion, extension, and lateral flexion of lumbar spine. X-ray of spine revealed flowing calcification of anterior longitudinal ligaments from cervical to lumbar spine with claw osteophytes giving rise to characteristic ‘Melting Wax’ appearance (Panel A: fig A- cervical anteroposterior (AP), fig B- cervical lateral , fig C- lumbar AP , fig D- lumbar lateral) (Panel B: fig E- thoracolumbar AP, fig F- thoracolumbar lateral). Sacroiliac joints were normal (Panel A: fig C- white arrow). The diagnosis was diffuse idiopathic skeletal hyperostosis (DISH or Forestier’s disease) and symptomatic treatment was initiated.