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. 2021 Mar 17;9:19. doi: 10.1038/s41413-021-00140-6

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 6 — Ossification in spine soft tissues by CT in AS patients. a Male, aged 45 years. 1 Supraspinous ligament and Interspinous ligament. 2 Vertebral disk. 3 Supraspinous ligaments. 4 Posterior longitudinal ligaments. b Male, aged 37 years. 1 Anterior longitudinal ligament. 2 Interspinous ligament. 3 Interspinous ligament and supraspinous ligament. 4 Interspinous ligament and ligamentum flavum. c Female, aged 33 years. 1 Vertebral disk. 2 Interspinous ligament and Ligamentum flavum. 3 Interspinous ligament. 4 Anterior longitudinal ligaments. The right four panels show magnified views of the red boxed area in the left panels. d Hypothetical diagram of pathological progression of AS. Excessive TGF-β is produced by abundant immune cells due to autoimmune disease, then TGF-β recruits MSCs results in chondrocytes proliferation, hypertrophy, and calcification. Numbers of giant osteoclasts keep resorbing calcified cartilage and freeing TGF-β from lap, continuous high level of TGF-β recruits MSCs for vessels formation and osteoblasts differentiation, osteoclasts also induce the innervation process