Version June 2024
| Criteria of Resnick and Niwayama |
| 1. The presence of flowing calcification and ossification along the anterolateral aspect of at least four contiguous vertebral bodies with or without associated localized pointed excrescences at the intervening vertebral body-intervertebral disc junctions. |
| 2. The presence of relative preservation of intervertebral disc height in the involved vertebral segment and the absence of extensive radiographic changes of "degenerative" disc disease, including vacuum phenomena and vertebral body marginal sclerosis. |
| 3. The absence of apophyseal joint bony ankylosis and sacroiliac joint erosion, sclerosis, or intraarticular osseous fusion. |
| Criteria of Utsinger |
| 1. Continuous ossification along the anterolateral aspect of at least four contiguous vertebral bodies, primarily in the thoracolumbar spine. Ossification begins as a fine, ribbon-like wave of bone but commonly develops into a broad, bumpy, buttress-like band of bone. |
| 2. Continuous ossification along the anterolateral aspect of at least two contiguous vertebral bodies. |
| 3. Symmetrical and peripheral enthesopathy involving the posterior heel, superior patella, or olecranon, with the entheseal new bone having a well-defined cortical margin. |
| Exclusions: |
| i) Abnormal disc space height in the involved areas |
| ii) Apophyseal joint ankylosis |
| Categories of DISH according to the Utsinger criteria are: |
| Definite = criterion 1 |
| Probable = criteria 2 and 3 |
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