Differentiating between Traumatic Pathology and Congenital Variant: A Case Report of Butterfly Vertebra

Abstract

Butterfly vertebra is a rare congenital malformation of the spine, which is usually reported in the literature as an isolated finding. We describe a 40-year-old woman that presented to our emergency department with back pain and sciatica. Initial radiological evaluation revealed an incidental finding of a L4 butterfly vertebra in the anteroposterior and lateral view radiographs. The patient presented with no neurological deficit. This rare congenital anomaly is usually asymptomatic, and awareness of its non-traumatic nature is critical in order to establish a correct diagnosis. Further evaluation of the patient is necessary to exclude pathologic fracture, infection, or associated vertebral anomalies and syndromes, such as Alagille, Jarcho-Levin, Crouzon, and Pfeiffer syndromes. Furthermore, in the emergency setting, awareness of this entity is needed so that a correct diagnosis can be established.

Spinal cord injury in an adult patient with thoracic butterfly vertebra: a case report and review of the literature

“…In addition, the disc of the defective vertebra may show density irregularities continuous with the discs above and below the butterfly vertebra. Awareness of these imaging features is critical for making a correct diagnosis [8]. In the present case, the Fig.…”

“…Butterfly vertebrae present a wedge-shaped configuration on a lateral view and can be easily confused with a compression fracture [7][8][9][10][11]. In an anteroposterior view, the butterfly vertebra is split into two hemivertebrae, and the pedicles appear divergent.…”

Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part III Lumbosacral Spine

“…The defect is characterized by anterior and median aplasia [20,21]. The sacral vertebra has a prominent midline cleft (arrows) through the body, giving the sacrum a funnel shape at the caudal end, hence the butterfly appearance on imaging It represents a defect in the vertebral body formation characterized by anterior and median aplasia [21,22]. The vertebra has a cleft through the body and a funnel shape at the ends, which gives it a butterfly appearance on AP radiographs.…”

“…The vertebra has a cleft through the body and a funnel shape at the ends, which gives it a butterfly appearance on AP radiographs. Typically, it occurs in the lumbar spine and can be an isolated finding or can be associated with other congenital syndromes, such as Alagille's, Jarcho-Levin's, and Pfeiffer's syndromes [20,21]. The body's butterfly shape can be seen easily on simple AP radiographs, while the pedicles may look divergent.…”

“…However, in lateral radiographs, the butterfly vertebra appears wedge-shaped and thus can be confused with a compression fracture. There also are degenerative changes of the intervertebral discs above and below the butterfly vertebra that can make it more complicated to identify lumbar vertebra on intraoperative x-rays [21].…”