Diffuse idiopathic skeletal hyperostosis is a frequently misdiagnosed condition due to its overlapping features with degenerative disc disease, ankylosing spondylitis and osteoarthritis. Its hallmark radiographic features should not be overlooked as they may play a key role in the identification of the disease. These features include flowing ossifications along the anterior longitudinal ligament of at least four contiguous vertebrae, with preserved intervertebral disc spaces and the absence of sacroiliitis. Unlike ankylosing spondylitis, this condition is non-inflammatory, and even when inflammation is present, it is of mild intensity and often presenting with normal levels of inflammatory markers. Beyond spinal involvement, diffuse idiopathic skeletal hyperostosis may cause significant peripheral enthesopathy, dysphagia due to cervical spine ossification and increased risk of spinal fractures, manifestations that are frequently overlooked along with metabolic syndrome. Early recognition must address both musculoskeletal symptoms and metabolic disturbances in order to achieve better outcomes and prevent further pain and reduced spinal mobility along with systemic complications.