Objective To characterize the imaging distribution of vertebral osteophytes and to assess their association with clinical symptom severity. Methods A retrospective analysis was conducted on clinical data from 80 patients diagnosed with vertebral osteophytes who were treated at Pengyang Hospital of Traditional Chinese Medicine from January 2022 to December 2024. The study evaluated the affected vertebral segments, distribution patterns, number of involved segments, and grading of osteophyte severity. Differences in imaging characteristics among groups with varying symptomatic severity were compared, and correlations between radiological indicators and the severity of clinical symptoms were assessed. Results No significant differences in involved spinal segments were observed among symptom severity groups (all P＞0.05). Multilevel involvement and higher osteophyte grades were more frequent in patients with moderate and severe symptoms (all P＜0.05). Posterior and composite distribution patterns were more common in patients with more severe symptoms. Spearman analysis demonstrated positive correlations between osteophyte grade, number of affected segments, posterior or composite involvement, and symptom severity (all P＜0.05). Conclusion The imaging characteristics of vertebral osteophytes are associated with clinical symptom severity. Multilevel involvement, posterior or composite distribution, and higher osteophyte grades are more likely to be accompanied by severe symptoms. Computed tomography (CT) provides important value in delineating these features and supporting clinical assessment.