Brian Livingstone, Andrew Kitchener, Gordon Hull , Tobias Schwarz, Sanjay Vijayanathan, Matthew J. Allen , Matyas Liptovszky, Roberto Portela Miguez

Research output: Contribution to journalArticlepeer-review


Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a disorder of unknown cause, in which new bone forms in soft tissues attached to the skeleton. Originally described in humans, in whom it is quite common, it is usually asymptomatic. New bone may completely bridge across joints, especially in the spine. However, it can be difficult to distinguish from diseases such as spondyloarthritis and spondylosis. With safer and increased use of radiography in diagnosis, the unfamiliar skeletal changes of asymptomatic DISH may now be coincidentally revealed during investigation of other disorders and result in misdiagnosis and unnecessary treatment. There have been case reports of its occurrence in great apes, but this is the first study to illustrate its appearances in a series of eleven skeletons of western and eastern lowland gorillas (Gorilla gorilla gorilla and G. beringei graueri) from zoos in Europe and the USA. The study combines review of available clinical and post-mortem records with examination of the skeletons and radiological investigation, such as CT. The results indicate that the disorder is probably common in older (>30yr.) captive gorillas but that it is asymptomatic. It was not symptomatic during life in any of these animals. There were unexpected features in several cases, such as extensive involvement of the thorax, extra-articular sacroiliac and tibiofibular joint fusions that are not typical in humans. By illustrating these skeletons, the study should aid differentiation of DISH from spondylosis (syn spondylosis deformans) and spondyloarthritis. It illustrates those features that are atypical of human DISH. CT scanning is valuable in such cases for examining diagnostically important areas such as sacroiliac joints. Increased awareness of DISH should help with understanding its cause, both in gorillas and humans.
Original languageEnglish
JournalJournal of Zoo and Wildlife Medicine
Publication statusPublished - 16 Nov 2020


  • diagnosis
  • DISH
  • Gorilla
  • imaging
  • skeleton
  • spine


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