Two-hundred paraplegic men were studied to determine the nature of their axial skeletal changes. Forty-two per cent had sacro-iliac (SI) joint changes which varied from marginal blurring, erosion, sclerosis, and narrowing of the joint space (9%) to complete obliteration of the joints (33%). Radiographs of the thoracolumbar spine revealed syndesmophytes (9%), interspinous ossification (2%), intervertebral disk calcification (1.5%), and large osteophytes (2%). These changes had no relation to race, age (except spine changes), or paralysis level, but were related to the duration of the paralysis. The observed skeletal changes mimic HLA-B27 arthropathy. However, the presence of para-osteoarthropathies and negative HLA-B27 in paraplegics would help in differential diagnosis.