Table 1.

Criteria definitions for diffuse idiopathic skeletal hyperostosis.

Criteria	Characteristics for “Definite” DISH	Comment
Contemporary*	Variations on spinal bony bridges.	No specific criteria stated.
Bywaters [2]	Complete bridge between 2 vertebral bodies with normal intervening disc.	Describes a minimal / inadequate criteria set.
Julkunen [3]	Lateral thoracic spine x-ray showing “two typical hyperostotic bridges”.	Radiological criteria for epidemiological purposes.
Harris [4]	Hypertrophic bony spurs with at least 2 bony bridges, normal sacro-iliac joints	Excluded changes associated with other identifiable spinal disease
Resnick and Niwayama [5]	Bridging of four contiguous vertebral bodies, minimal intervertebral disc disease, no facet joint ankylosis and no sacro-iliac joint inflammatory changes.	Most widely used criteria, does not include extra-spinal changes.
Arlet and MaziÉres [6]	Bridging of three contiguous vertebral bodies located in lower thoracic region, minimal intervertebral disc disease, no facet joint ankylosis no intra-articular erosion or ossification of sacro-iliac joints.	“Possible DISH” allowed with variations of criteria allowed.
Utsinger [7]	Bridging of four contiguous vertebral bodies primarily in thoracolumbar spine, minimal intervertebral disc disease, no facet joint ankylosis.	‘Probable DISH” if bridging of two contiguous vertebral bodies plus bilateral patellar tufting, heel spurring and olecranon tufting. “Possible DISH” if two vertebrae joined in absence of extra-spinal enthesophytes or symmetrical extra-spinal enthesophytes in absence of spinal involvement.
Rogers and Waldron [8]	Ossification of anterior longitudinal ligament affecting 3 vertebrae (with/without) ankylosis, confined to right side of thoracic spine, evidence of symmetrical extra-spinal DISH, including patellar tufting, heel spurring, olecranon tufting, ossification of ligamentum flavum and spurring of tibial tuberosities. Lack of intervertebral changes not required for diagnosis.	Criteria used in paleopathological health assessments.
Maat et al. [9]	Spinal ligament ossifications of four or more contiguous vertebral levels and/or extensive peripheral enthesopathies	Criteria used in paleopathological health assessments.
CrubÉzy [10]	Bridging of two intervertebral spaces at the lower thoracic spine or bridging of three intervertebral spaces at any level. Decreased disc height in elderly subjects and para-articular bony bridging of the sacroiliac joints do not rule out the diagnosis	Probable DISH if flowing ossification along the anterolateral aspect of at least two contiguous vertebras and enthesopathies without remodeling of the cortex symmetrically involving the posterior calcanei, olecranons, and upper patellae.

^*Various authors.