Criteria
There is a lack of universally accepted, validated criteria. Resnick and Niwayama are the most commonly used. Subsequent groups have described alternative criteria as detailed below.
Resnick and Niwayama[52]
Presence of vertebral 'flowing' ossifications at a minimum of 4 contiguous vertebrae
Preservation of disc height and lack of significant degenerative changes at the involved vertebral segments
Absence of ankylosis at the facet-joint interface and absence of sacroiliac joint erosion, sclerosis, or fusion
Arlet and Mazières[39]
Presence of vertebral ossifications bridging a minimum of 3 contiguous vertebrae in the lower thoracic spine
No peripheral enthesopathies required
Ossification in the vicinity of the sacroiliac joint allowed
Rogers and Waldron[40]
Presence of vertebral ossifications bridging a minimum of 3 contiguous vertebrae in the thoracic spine
Peripheral calcification or ossification of ligaments and/or entheses
Criteria for early-phase diffuse idiopathic skeletal hyperostosis[38]
Score 0 to 3 assigned for each vertebral segment adjacent to a complete bone bridge, depending on:
presence of osteophytes
near complete bridging (<2 mm distance between bony structures)
complete bridging (full connection between 2 adjacent bones with abundant new bone formation)
The presence of <3 adjacent segments with a complete bone bridge is identified as early DISH
The presence of ≥3 is definite DISH.
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