Patterns of Vertebral Ossification in Paralyzed Patients

Four patterns of vertebral ossification abnormalities can be seen in paraplegic and quadriplegic patients. These resemble osteophytes, syndesmophytes, irregular paraspinal ossifications, and flowing ossifications.

• Osteophytes: Originate near the superior and inferior margins of the vertebral bodies.
• Paraspinal ossifications: Irregular, asymmetric ossification affecting paravertebral soft tissues with an appearance similar to that of psoriasis.
• Syndesmophytes: Thin areas of ossification with a symmetric vertical orientation in the outer portions of the annulus fibrosus, mimicking ankylosing spondylitis.
• Flowing ossifications: Similar to those seen with diffuse idiopathic skeletal hyperostosis (DISH). Seen in 3% of quadriplegic and 1% of paraplegic patients (may not be significantly higher than that found in the general population).

The frequency of vertebral ossification seems to be depend on age and duration of paralysis in both quadriplegic and paraplegic patients. The image above is from a patient with spinal cord injury. We see paravertebral ossifications at T3-T4 and T4-T5 with preserved disc spaces. The appearance at T3-T4 is more akin to an osteophyte, while the appearance at T4-T5 is closer to a syndesmophyte.

References

• Park YH, Huang GS, Taylor JA, Marcelis S, Kramer J, Pathria MN, Clopton P, Resnick D. Patterns of vertebral ossification and pelvic abnormalities in paralysis: a study of 200 patients. Radiology. 1993 Aug;188(2):561-5.
• Killebrew K, Gold RH, Sholkoff SD. Psoriatic spondylitis. Radiology. 1973 Jul;108(1):9-16.