Syndesmophytes are calcifications or heterotopic ossifications inside a spinal ligament or of the annulus fibrosus.
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Pathology
Syndesmophytes are seen in only a limited number of conditions including:
They can be classified as marginal (along the margins of the vertebral bodies) or non-marginal (larger and bulky away from the vertebral bodies). Ankylosing spondylitis classically displays symmetrical marginal syndesmophytes. Enteropathic arthritis is also demonstrating marginal syndesmophytes. Psoriatic arthritis and reactive arthritis classically have non-marginal unilateral or asymmetrical syndesmophytes 5.
Radiographic features
Plain radiograph
Appearance on plain radiographs comprises vertical and symmetrical calcification of the lateral margins of the intervertebral disc space.
Differential diagnosis
osteophyte: ossification at synovial margins, typically protruding perpendicular to the spine cf. syndesmophytes that run parallel with the spine. However, bridging osteophytes and large syndesmophytes can have similar appearance, both oriented between vertical and horizontal 5
enthesophyte: located at an attachment of a ligament or tendon, not associated with a joint
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