Syndesmophytes and osteophytes can look very similar on imaging and it is sometimes difficult to differentiate between the two. This illustration highlights the salient difference in etiology of these two processes. The ossification seen in syndesmophytes originates from the annulus fibrosis of the intervertebral disc and spinal ligaments (anterior longitudinal and posterior longitudinal ligament ossification shown in the illustration.They occur in inflammatory spondyloarthropathies such as ankylosing spondylitis. The Romanus lesions are associated with these conditions. With osteophytes the ossification originates from the vertebral body itself and most commonly occur due to osteoarthritis.