Diffuse Idiopathic Skeletal Hyperostosis as a Cause of Failure Following Distal Clavicle Excision: A Case Report and Review of the Literature

Diffuse idiopathic skeletal hyperostosis (DISH) is common spinal condition characterized by increased calcification and ossification of ligaments and entheses, typically in the anterior aspect of the spine. However, extraspinal manifestations of the disease can occur and depending on the degree and location of involvement, may become symptomatic. We present the case of a 63-year-old male with a history of DISH, who failed initial open distal clavicle excision due to the postoperative development of heterotopic bone bridging across the acromioclavicular joint. Revision open distal clavicle excision coupled with postoperative heterotopic ossification prophylaxis led to a successful clinical and functional outcome without heterotopic bone recurrence. The case description is followed by a review of the extraspinal manifestations of DISH and the recommended prophylactic management in patients with DISH and similar risk factors for the development of heterotopic ossification.