A radiologic-pathologic correlative investigation of the normal age-related alterations in the spinous processes and intervening soft tissues was performed using cadaveric spines and both ancient and modern macerated vertebral specimens. Extreme lordosis in the cervical or lumbar spine results in spinous process apposition, formation of interspinous bursae, eburnation with osteophytosis, and creation of synovial articulations. A concomitant degenerative enthesopathy involves the supraspinous or interspinous ligamentous attachments in any spinal segment. The differential diagnosis of this phenomenon, the clinical significance of which in a given patient is controversial, includes rheumatoid and other inflammatory arthritides as well as crystal deposition disease.