Amalgamation of Various Vertebral Anomalies: A Rare Case Report

Abstract

Congenital vertebral anomalies are the collection of malformations of spine, which include alterations of the shape and number of vertebrae. Here is a case report of 15 years old male child with a combination of various vertebral anomalies such as hemi-vertebra, block-vertebra, butterfly vertebra, absence of S4 and S5 vertebras and the coccyx along with agenesis of left kidney who was detected by Karuna Foundation Nepal during its project instance.

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ISSN: 2165-7939
Journal of Spine
Khanal et al., J Spine 2016, 5:6
DOI: 10.4172/2165-7939.1000350
Case Report OMICS International
Volume 5 • Issue 6 • 1000350
J Spine, an open access journal
ISSN: 2165-7939
Amalgamation of Various Vertebral Anomalies: A Rare Case Report
Dildip Khanal*, Krishna Prasad Sapkota and Rupa Shiwakoti
Karuna Foundation Nepal (KFN) “Saving Children From Disability, One By One” 294 Embassy Margh, Baluwatar, Kathmandu, Nepal
Abstract
Congenital vertebral anomalies are the collection of malformations of spine, which include alterations of the shape
and number of vertebrae. Here is a case report of 15 years old male child with a combination of various vertebral
anomalies such as hemi-vertebra, block-vertebra, buttery vertebra, absence of S4 and S5 vertebras and the coccyx
along with agenesis of left kidney who was detected by Karuna Foundation Nepal during its project instance.
*Corresponding author: Dildip Khanal, Senior Program Ofcer, Karuna
Foundation Nepal (KFN) “Saving Children From Disability, One By One” 294
Embassy Margh, Baluwatar, Kathmandu, Nepal, Tel: 01- 4410687, 4413340; Fax:
01- 4413719; E-mail: dildip17@gmail.com
Received December 06, 2016; Accepted December 21, 2016; Published December
23, 2016
Citation: Khanal D, Sapkota KP, Shiwakoti R (2016) Amalgamation of Various
Vertebral Anomalies: A Rare Case Report. J Spine 5: 350. doi: 10.4172/2165-
7939.1000350
Copyright: © 2016 Khanal D, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Congenital vertebral anomalies; Hemi-vertebra; Block-
vertebra; Buttery vertebra; Karuna Foundation Nepal (KFN)
Background
Congenital vertebral anomaly may commonly (global prevalence
of 0.5–1/1,000 live births), encounter but an amalgamation of various
vertebral anomalies is unusual. Congenital vertebral anomalies are the
collection of malformations of spine, which include alterations of the shape
and number of vertebrae. is paper does not aim to provide any specic
intervention, but to underscore on the available information [1].
Karuna foundation Nepal (KFN) is a non-governmental
organization which believes in a world in which each individual, with
or without disabilities, has equal access to good quality health care,
can lead a dignied life, and can participate as much as possible in
community life. KFN approach is entrepreneurial and action oriented,
working towards setting up and strengthening existing local health
care system, stimulating community participation and responsibility-
including health promotion, prevention, and rehabilitation through
empowerment of communities. Below is a description of a child with
such a rare case who was identied during one of KFN project [2].
Case Report
Mother of 15 years old male child approached KFN, with complain
of the inability of her son to have control in the passage of urine and
stool since birth. As a support for medical intervention, he was taken to
tertiary level hospital by KFN. According to his mother, she noticed the
problem when the child started to walk independently and was able to
communicate. Child developmental milestones were normal.
Family history: ere was no history of consanguinity. All other
children were normal.
Physical examination: e child was moderately built. Motor,
sensory and reex examinations were normal with no limb length
discrepancy. Cervical scoliosis was noted.
Ultrasound of abdomen and pelvic region shows a hyper echoic
focus with faint posterior acoustic shadowing in lower 3rd calyx of right
kidney likely nephrolithiasis; dilated right pelvicalyceal structures,
indicating Grade I Hydronephrosis, le kidney cannot be visualized
(Figure 1).
Impression on MRI were cervical scoliosis with convexity to le,
bony defects in anterior and posterior arch of C1 vertebra, absent of
le hemi half of C3 vertebra and right hemi half of C3 vertebra with C2
vertebra, right lateral wedging of C5, C6 buttery vertebra, absent right
hemi half of C7 vertebra and fused le hemi half of C7 vertebra with
D1 vertebra, absent S4 and S5 vertebras and the coccyx, reduced C6-C7
and D1-D2 disc space, C3/C4 and C4/C5 disc bulge, lumbar disc bulge,
ligamentus avum thickening at L4-L5 and L5-S1 levels, le kidney is
not well visualized-Agenesis, prominent adenoid and normal screening
MRI study of the head (Figures 2-4).
Discussion and Conclusion
Hemi-vertebra is wedge-shaped vertebra, resulting from a lack of
formation of one half of a vertebral body. It falls under the spectrum
of segmentational anomalies and can involve one or multiple levels.
It can be a common cause of a congenital scoliosis. Among the
congenital vertebral anomalies, hemi-vertebra are the most likely to
cause neurologic problems. e most common location is the mid-
thoracic region, especially the T8. Neurologic signs results from severe
angulation of the spine, narrowing of the spinal canal, instability of the
spine and luxation or fracture of the vertebra. Signs include rear limb
Figure 1: Agenesis of left kidney.

Citation: Khanal D, Sapkota KP, Shiwakoti R (2016) Amalgamation of Various Vertebral Anomalies: A Rare Case Report. J Spine 5: 350. doi:
10.4172/2165-7939.1000350
Page 2 of 2
Volume 5 • Issue 6 • 1000350
J Spine, an open access journal
ISSN: 2165-7939
Buttery vertebra is a type of vertebral anomaly that results from
the failure of fusion of the lateral half of the vertebral body because
of persistent notochordal tissue between them. Also, known as sagittal
cle vertebra, this anomaly is usually asymptomatic and detected
incidentally. It may be isolated or associated with other spinal anomalies
such as Kypho-scolosis, hemi-vertebra or Spina bida, other congenital
syndromes or chromosomal defects. is anomaly was rst described
in 1844 by Rokitansky, while examining the 12th thoracic vertebra of a
55-year-old man [7-9].
e literature includes few cases reporting of dierent vertebral
anomalies but to our knowledge, association of various vertebral
anomalies along with le kidney agenesis in one person has not been
described yet.
References
1. Brand MC (2008) Examination of the newborn with congenital scoliosis: focus
on the physical. Adv Neonatal Care 8: 265-273.
2. Karuna Foundation (2016) About Karuna.
3. Radiopaedia.org. (2016) Vertebral anomalies.
4. Jalanko T, Rintala R, Puisto V, Helenius I (2011) Hemivertebra resection for
congenital scoliosis in young children: comparison of clinical, radiographic, and
health-related quality of life outcomes between the anterior and posterolateral
approaches. Spine 36: 41-49.
5. Medspace (2016) Congenital spinal deformity.
6. Wikipedia (2016) Congenital vertebral anomaly.
7. Ozaras N, Gumussu K, Demir SE, Rezvani A (2105) Differential diagnosis of
multiple vertebral compression: buttery vertebra: J Phys Ther Sci 27: 3601-
3603.
8. Sonel B, Yalçin P, Oztürk EA, Bökesoy I (2001) Buttery vertebra: A case
report. Clin Imaging 25: 206-208.
9. Delgado A, Mokri B, Miller GM (1996) Buttery vertebra 6: 56-58.
Figure 2: Shows hemi-vertebra, absent of S4 and S5 vertebras and the coccyx.
Figure 4: Buttery-vertebra, absent of S4 and S5 vertebras and the coccyx.
Figure 3: Block-vertebra, absent of S4 and S5 vertebras and the coccyx.
weakness or paralysis, urinary or fecal incontinence and spinal pain.
Most case of hemi-vertebra have no or mild symptoms, so treatment is
usually conservative while severe cases may respond to surgical spinal
cord decompression and vertebral stabilization [3,4].
Block vertebra occurs when there is improper segmentation of
the vertebra, leading to parts of or the entire vertebra being fused. e
adjacent vertebra fuses through their intervertebral discs and through
other intervertebral joints so that it can lead to blocking or stretching
of the existing nerve roots from that segment. It may lead to certain
neurological problems depending on the severity of the block. It can
increase stress on the inferior and the superior intervertebral joints. It
can lead to abnormal angle in the spine, there are certain syndromes
associated with block vertebra for example Klippel-Feil Syndrome [5,6].
Citation:
Khanal D, Sapkota KP, Shiwakoti R (2016) Amalgamation of Various
Vertebral Anomalies: A Rare Case Report. J Spine 5: 350. doi: 10.4172/2165-
7939.1000350