Butterfly Vertebra

Gopinathan, Patinharayil; Han, Chan W.; Marthya, Anwar; Meethall, Kumaran C.; Surendran, Sibin; Rudrappa, Girish H.

doi:10.1097/brs.0b013e31818ad3e1

Cited by 27 publications

(13 citation statements)

References 12 publications

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“…Hemivertebra is characterized by a wedge-shaped vertebra with the absence (aplasia) of one of the two chondrification centers within the vertebral body, resulting in substantial deformity of the spine [15] in its sagittal and coronal alignment. Butterfly vertebra refers to the failure of fusion of two chondrification centers with the persistent notochord separating them [7, 23]. Both hemivertebra and butterfly vertebra may be associated with skeletal anomalies [12], diastematomyelia [20], cardiac, urogenital and gastrointestinal anomalies, and some conditions including Jarcho–Levin, Klippel-Fiel, VATER, VACTERL, and OEIS syndromes [30].…”

Section: Discussionmentioning

confidence: 99%

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New anatomical data on the growing C4 vertebra and its three ossification centers in human fetuses

Baumgart

Szpinda

2012

Surg Radiol Anat

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PurposeDetailed knowledge on the normative growth of the spine is of great relevance in the prenatal diagnosis of its abnormalities. The present study was conducted to compile age-specific reference data for vertebra C4 and its three ossification centers in human fetuses.Materials and methodsWith the use of CT (Biograph mCT), digital image analysis (Osirix 3.9) and statistical analysis (Wilcoxon signed-rank test, Kolmogorov–Smirnov test, Levene’s test, Student’s t test, one-way ANOVA, post hoc RIR Tukey test, linear and nonlinear regression analysis), the normative growth of vertebra C4 and its three ossification centers in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17–30 weeks was examined.ResultsSignificant differences in neither sex nor laterality were found. The height and transverse and sagittal diameters of the C4 vertebral body increased logarithmically as: y = −3.866 + 2.225 × ln(Age) ± 0.238 (R2 = 0.69), y = −7.077 + 3.547 × ln(Age) ± 0.356 (R2 = 0.72) and y = −3.886 + 2.272 × ln(Age) ± 0.222 (R2 = 0.73), respectively. The C4 vertebral body grew linearly in cross-sectional area as y = −7.205 + 0.812 × Age ± 1.668 (R2 = 0.76) and four-degree polynomially in volume as y = 14.108 + 0.00007 × Age4 ± 6.289 (R2 = 0.83). The transverse and sagittal diameters, cross-sectional area and volume of the ossification center of the C4 vertebral body generated the following functions: y = −8.836 + 3.708 × ln(Age) ± 0.334 (R2 = 0.76), y = −7.748 + 3.240 × ln(Age) ± 0.237 (R2 = 0.83), y = −4.690 + 0.437 × Age ± 1.172 (R2 = 0.63) and y = −5.917 + 0.582 × Age ± 1.157 (R2 = 0.77), respectively. The ossification center-to-vertebral body volume ratio gradually declined with age. On the right and left, the neural ossification centers showed the following growth: y = −19.601 + 8.018 × ln(Age) ± 0.369 (R2 = 0.92) and y = −15.804 + 6.912 × ln(Age) ± 0.471 (R2 = 0.85) for length, y = −5.806 + 2.587 × ln(Age) ± 0.146 (R2 = 0.88) and y = −5.621 + 2.519 × ln(Age) ± 0.146 (R2 = 0.88) for width, y = −9.188 + 0.856 × Age ± 2.174 (R2 = 0.67) and y = −7.570 + 0.768 × Age ± 2.200 (R2 = 0.60) for cross-sectional area, and y = −13.802 + 1.222 × Age ± 1.872 (R2 = 0.84) and y = −11.038 + 1.061 × Age ± 1.964 (R2 = 0.80) for volume, respectively.ConclusionsThe morphometric parameters of vertebra C4 and its three ossification centers show no sex differences. The C4 vertebral body increases logarithmically in height and both sagittal and transverse diameters, linearly in cross-sectional area, and four-degree polynomially in volume. The three ossification centers of vertebra C4 grow logarithmically in both transverse and sagittal diameters, and linearly in both cross-sectional area and volume. The age-specific reference intervals for evolving vertebra C4 may be useful in the prenatal diagnosis of congenital spinal defects.

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Section: Discussionmentioning

confidence: 99%

“…Both CT and MRI examinations of the vertebral column are often superior to ultrasonography for evaluation of spinal anomalies [6, 8, 12, 15, 19, 21]. Detailed knowledge on the normative growth of the spine is relevant for diagnosing its abnormalities [12, 15, 23, 30, 33] and skeletal dysplasias [29]. …”

Section: Introductionmentioning

confidence: 99%

New anatomical data on the growing C4 vertebra and its three ossification centers in human fetuses

Baumgart

Szpinda

2012

Surg Radiol Anat

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“…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].…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional study of the neural ossification centers of vertebrae C1–S5 in the human fetus

et al. 2013

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PurposeAn 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 methodsUsing 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.ResultsThe 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.ConclusionsThe 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.

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“…Most often, the butterfly vertebra are asymptomatic and do not require treatment. [12] This is well illustrated in a reported case of Larsen syndrome with AAD, where the C3–C4 bodies were hypoplastic with kyphotic deformity. [13] The hypoplastic C3–C4 vertebrae were not treated and the patient improved with treatment of AAD alone.…”

Section: Discussionmentioning

confidence: 72%

“…[111213] The absence of C2 posterior arch poses a technical challenge. In normal anatomy or even in segmentation defects, tracing the superomedial border of C2 lamina helps in reaching the C1–C2 joints.…”

Section: Discussionmentioning

confidence: 99%

Case of atlantoaxial dislocation with assimilated C1, absent posterior C2, butterfly C3, and fused subaxial cervical spine: Management dilemma with multiple segmentation and formation defects

2017

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Segmentation defects are often seen with congenital atlantoaxial dislocation (AAD) though an associated absence of posterior arch of C2 and butterfly C3 is rare. Apart from rarity, the combination of formation and segmentation defects adds to the management dilemma. We report a case of AAD with assimilated atlas, absent C2 posterior arch, C3 butterfly vertebra with floating posterior elements, and fused C4–C6. The child was managed by C1–C2 fusion alone with immediate symptomatic improvement. The presence of formation defects such as adjacent butterfly vertebra and absent posterior elements does not alter the management of AAD. Fusing the C1–C2 joints appears to be a balanced approach.

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Butterfly Vertebra

Abstract: 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.

Cited by 27 publications

References 12 publications

New anatomical data on the growing C4 vertebra and its three ossification centers in human fetuses

New anatomical data on the growing C4 vertebra and its three ossification centers in human fetuses

Cross-sectional study of the neural ossification centers of vertebrae C1–S5 in the human fetus

Case of atlantoaxial dislocation with assimilated C1, absent posterior C2, butterfly C3, and fused subaxial cervical spine: Management dilemma with multiple segmentation and formation defects

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