An experienced two rheumatologist and one radiologist independently scored the radiographs for the presence or absence of a bone bridge for each intervertebral disc space (IDS) from T12–L1 to L4–L5. Lumbar spine radiography was used to evaluate the anterior and lateral sides of the vertebral body. The number of bone bridges was verified in the upper and lower bone bridge in one vertebra, in the anterior and lateral sides, and was scored up to a maximum of 6 points based on radiographic findings. The score was 0 if no syndesmophyte or < 90% syndesmophyte of the IDS was present and 1 if the syndesmophyte bridges the IDS or ≥ 90% syndesmophyte of the IDS was present. The schematic presentation and scoring are presented in Fig 1.

(A) Schematic coronal and sagittal views of vertebrae with syndesmophytes. The gray, dotted line indicates the middle of the intervertebral disc space (IDS). Scoring was performed at the four corners of the coronal view and at the two corners of the anterior side of the sagittal view per vertebra (asterisk) with 0 or 1 point. A score of 0 is given for no syndesmophyte or < 90% syndesmophyte (a), and a score of 1 is given for ≥ 90% syndesmophyte of the IDS (b). (B) Anteroposterior radiographic image of the lumbar spine. At L3, a bridging syndesmophyte or ankylosis is seen (black arrow). A score of 1 is given for the upper left corner of L3 and the lower left corner of L3. No syndesmophytes are present at the right corner of L3 (dashed arrow), which is given a score of 0. (C) Lateral radiographic image of the lumbar spine. At the anterior side of L4, a syndesmophyte is growing from the upper corner (arrowhead) but does not reach ≥ 90% of the IDS, which is given a score of 0. At the anterior side of the vertebrae units L2–L3 (black arrow), a bridging syndesmophyte is seen (black arrow), and a score of 1 is given for the anterior upper corner of L3 and the anterior lower corner of L2. No syndesmophytes are present at the anterior lower corner of L3 (dashed arrow), which is given a score of 0.

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