A lateral lumbar spine radiograph of a 60-year-old man shows thick, flowing right-sided ossification along the anterior aspect of at least four contiguous vertebral bodies with preserved disc heights and normal facet joints. The most likely diagnosis is:

• A Diffuse idiopathic skeletal hyperostosis ✓
• B Ankylosing spondylitis
• C Osteoarthritis of the spine
• D Psoriatic spondylitis

Explanation

Flowing candle-wax-like ossification along the anterolateral aspect of four or more contiguous vertebrae with relative preservation of disc height and normal apophyseal (facet) joints meets the Resnick criteria for diffuse idiopathic skeletal hyperostosis. It is commoner in older men and associated with diabetes mellitus. In ankylosing spondylitis, the syndesmophytes are thin, vertical, symmetric, and arise from the vertebral corners, and the sacroiliac joints and facet joints show inflammatory changes and fusion. Preserved disc height also argues against degenerative disc disease.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.