Article

Butterfly vertebra: An uncommon congenital spinal anomaly

Spine (Impact Factor: 2.3). 12/2008; 33(24):E926-8. DOI: 10.1097/BRS.0b013e31818ad3e1
Source: PubMed

ABSTRACT

This is a report of a patient with T6 butterfly vertebra, which is an uncommon congenital spinal anomaly.
To illustrate the significance of identifying butterfly vertebra that may be confused with other pathologic conditions like fractures, infections, and metastases.
We report a 46-year-old woman with butterfly vertebra of T6 spine. The patient presented with complaints of low back pain and examination showed an abnormal bony prominence at midthoracic level. Radiologic and hematologic investigations confirmed the presence of butterfly vertebrae at T6 level, which proved to be a coincidental finding along with nonspecific low back pain. Knowledge about this condition is very important, since the condition can be easily confused with a pathologic fracture.
The patient presented with a history of low back pain of 2 months. The patient was evaluated clinically and with hematological investigations. The diagnosis was confirmed with computerized tomography (CT) and magnetic resonance imaging (MRI) scans.
Routine examination of the motor and sensory system was found to be normal. Roentgenogram of the thoracic and lumbosacral spine showed anterior wedging of T6 vertebrae in the lateral view and features suggestive of the presence of a butterfly vertebra at T6 level in the anteroposterior (AP) view. Hematologic evaluation was done to rule out pathologic causes of anterior wedging of the vertebra like infections and metastases in the spine. MRI and CT scans of the spine confirmed the presence of T6 butterfly vertebra. Patient was treated for her low back pain and assured that the abnormal midthoracic bony prominence was a benign condition that needs no treatment.
A high index of suspicion is needed to identify this benign spinal anomaly that may be confused with many pathologic conditions. Knowledge of this condition helps in making rational use of extensive noninvasive and invasive diagnostic procedures.

3 Followers
 · 
515 Reads
  • Source
    • "The two methods of computed tomography (CT) and magnetic resonance imaging (MRI) are complementary, in fact often superior, to ultrasonographic scans in assessing suspected spinal anomalies [9, 22, 43]. Accurate knowledge on the normative growth of the spine is critical for diagnosing its congenital defects [13, 15, 24, 39, 46] and skeletodysplasias [38] that produce longitudinal growth imbalance. The height of a typical thoracic vertebra is approximately 3/4 and 4/3 of the heights of the lumbar and cervical vertebrae, respectively [2]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Knowledge on the normative growth of the spine is critical in the prenatal detection of its abnormalities. We aimed to study the size of T6 vertebra in human fetuses with the crown-rump length of 115–265 mm. Materials and methods Using the methods of computed tomography (Biograph mCT), digital image analysis (Osirix 3.9) and statistics, the normative growth of the T6 vertebral body and the three ossification centers of T6 vertebra in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17–30 weeks were studied. Results Neither male–female nor right–left significant differences were found. The height, transverse, and sagittal diameters of the T6 vertebral body followed natural logarithmic functions as y = −4.972 + 2.732 × ln(age) ± 0.253 (R2 = 0.72), y = −14.862 + 6.426 × ln(age) ± 0.456 (R2 = 0.82), and y = −10.990 + 4.982 × ln(age) ± 0.278 (R2 = 0.89), respectively. Its cross-sectional area (CSA) rose proportionately as y = −19.909 + 1.664 × age ± 2.033 (R2 = 0.89), whereas its volumetric growth followed the four-degree polynomial function y = 19.158 + 0.0002 × age4 ± 7.942 (R2 = 0.93). The T6 body ossification center grew logarithmically in both transverse and sagittal diameters as y = −14.784 + 6.115 × ln(age) ± 0.458 (R2 = 0.81) and y = −12.065 + 5.019 × ln(age) ± 0.315 (R2 = 0.87), and proportionately in both CSA and volume like y = −15.591 + 1.200 × age ± 1.470 (R2 = 0.90) and y = −22.120 + 1.663 × age ± 1.869 (R2 = 0.91), respectively. The ossification center-to-vertebral body volume ratio was gradually decreasing with age. On the right and left, the neural ossification centers revealed the following models: y = −15.188 + 6.332 × ln(age) ± 0.629 (R2 = 0.72) and y = −15.991 + 6.600 × ln(age) ± 0.629 (R2 = 0.74) for length, y = −6.716 + 2.814 × ln(age) ± 0.362 (R2 = 0.61) and y = −7.058 + 2.976 × ln(age) ± 0.323 (R2 = 0.67) for width, y = −5.665 + 0.591 × age ± 1.251 (R2 = 0.86) and y = −11.281 + 0.853 × age ± 1.653 (R2 = 0.78) for CSA, and y = −9.279 + 0.849 × age ± 2.302 (R2 = 0.65) and y = −16.117 + 1.155 × age ± 1.832 (R2 = 0.84) for volume, respectively. Conclusions Neither sex nor laterality differences are found in the morphometric parameters of evolving T6 vertebra and its three ossification centers. The growth dynamics of the T6 vertebral body follow logarithmically for its height, and both sagittal and transverse diameters, linearly for its CSA, and four-degree polynomially for its volume. The three ossification centers of T6 vertebra increase logarithmically in both transverse and sagittal diameters, and linearly in both CSA and volume. The age-specific reference intervals for evolving T6 vertebra present the normative values of potential relevance in the diagnosis of congenital spinal defects.
    Preview · Article · Mar 2013 · Anatomia Clinica
  • Source
    • "Three-dimensional ultrasonography plays a critical role in assessing and monitoring most fetal structures [8, 23–25], including the fetal spine after the 12th week of gestation [10, 11, 21, 22, 26, 28, 29]. Ossification of every vertebra starts with three primary centers, one body ossification center, and a pair of neural ossification centers [1–4, 6, 18, 20], which independently of each other evolve in the spine in a definite regional sequence [2]. The vertebral bodies begin to ossify in the distal thoracic-proximal lumbar spine and simultaneously progress both cranially and caudally [2, 22]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose An understanding of the normal evolution of the spine is of great relevance in the prenatal detection of spinal abnormalities. This study was carried out to estimate the length, width, cross-sectional area and volume of the neural ossification centers of vertebrae C1–S5 in the human fetus. Materials and methods Using the methods of CT (Biograph mCT), digital-image analysis (Osirix 3.9) and statistics (the one-way ANOVA test for paired data, the Kolmogorov–Smirnov test, Levene’s test, Student’s t test, the one-way ANOVA test for unpaired data with post hoc RIR Tukey comparisons) the size for the neural ossification centers throughout the spine in 55 spontaneously aborted human fetuses (27 males, 28 females) at ages of 17–30 weeks was studied. Results The neural ossification centers were visualized in the whole pre-sacral spine, in 74.5 % for S1, in 61.8 % for S2, in 52.7 % for S3, and in 12.7 % for S4. Neither male–female nor right–left significant differences in the size of neural ossification centers were found. The neural ossification centers were the longest within the cervical spine. The maximum values referred to the axis on the right, and to C5 vertebra on the left. There was a gradual decrease in length for the neural ossification centers of T1–S4 vertebrae. The neural ossification centers were the widest within the proximal thoracic spine and narrowed bi-directionally. The growth dynamics for CSA of neural ossification centers were found to parallel that of volume. The largest CSAs and volumes of neural ossification centers were found in the C3 vertebra, and decreased in the distal direction. Conclusions The neural ossification centers show neither male–female nor right–left differences. The neural ossification centers are characterized by the maximum length for C2–C6 vertebrae, the maximum width for the proximal thoracic spine, and both the maximum cross-sectional area and volume for C3 vertebra. There is a sharp decrease in size of the neural ossification centers along the sacral spine. A decreasing sequence of values for neural ossification centers along the spine from cervical to sacral appears to parallel the same direction of the timing of ossification. The quantitative growth of the neural ossification centers is of potential relevance in the prenatal diagnosis and monitoring of achondrogenesis, caudal regression syndrome, diastematomyelia and spina bifida.
    Preview · Article · Feb 2013 · Anatomia Clinica
  • Source
    • "As a result, the defective vertebra acts as a triangular wedge-shaped ossified structure, causing contralateral spine deviation [27]. Butterfly vertebra results from the failure of fusion of two chondrification centers, being separated by the persistent notochord [21]. Diastematomyelia as a spinal dysraphism is characterized by a sagittal cleft of the spinal cord with splaying of vertebral arches [18, 27]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Knowledge on the normative growth of the spine is relevant in the prenatal detection of its abnormalities. This study describes the size of the ossification center of C1–S5 vertebral bodies. Materials and methods Using CT, digital-image analysis, and statistics, the size of the ossification center of C1–S5 vertebral bodies in 55 spontaneously aborted human fetuses aged 17–30 weeks was examined. Results No sex significant differences were found. The body ossification centers were found within the entire presacral spine and in 85.5 % of S1, in 76.4 % of S2, in 67.3 % of S3, in 40.0 % of S4, and in 14.5 % of S5. All the values for the atlas were sharply smaller than for the axis. The mean transverse diameter of the body ossification center gradually increased from the axis to T12 vertebra, so as to stabilize through L1–L3 vertebrae, and finally was intensively decreasing to S5 vertebra. There was a gradual increase in sagittal diameter of the body ossification center from the axis to T5 vertebra and its stabilization for T6–T9 vertebrae. Afterward, an alternate progression was observed: a decrease in values for T10–T12 vertebrae, an increase in values for L1–L2 vertebrae, and finally a decrease in values for L3–S5 vertebrae. The values of cross-sectional area of ossification centers were gradually increasing from the axis to L2 vertebra and then started decreasing to S5 vertebra. The following cross-sectional areas were approximately equivalent to each other: for L5 and T3–T5, and for S4 and C1. The volumetric growth of the body ossification center gradually increased from the axis to L3 vertebra and then sharply decreased from L4 to S5. Conclusions No male–female differences are found in the size of the body ossification centers of the spine. The growth dynamics for morphometric parameters of the body ossification centers of the spine follow similarly with gestational age.
    Full-text · Article · Nov 2012 · Anatomia Clinica
Show more