Differential diagnosis of multiple vertebral compression: butterfly vertebrae

Butterfly vertebra and block vertebra cause overdiagnosis in trauma patients

Butterfly vertebra and block vertebra are usually reported incidental radiological view, which is a rare congenital defect of spine. Butterfly vertebra is a body formation characterized by anterior and median aplasia. The block vertebra is the result of an embryonically incomplete separation of vertebral bodies or arches or both. This rare congenital anomalies butterfly and block vertebra are usually stable and do not cause clinical symptoms.

Butterfly Vertebrae: A Systematic Review of the Literature and Analysis

STUDY DESIGN

Systematic review (Level 4).

OBJECTIVE

To summarize the demographics, clinical presentations, and conditions associated with butterfly vertebrae.

METHODS

A systematic search was performed of multiple databases. A total of 279 articles were identified for screening. Case series or case reports of butterfly vertebrae with adequate clinical detail were complied.

RESULTS

Eighty-two total articles (109 patients) were selected for final inclusion. Sixty-one percent of patients presented with a single butterfly vertebra, while 39% were multiple. The most common location for butterfly vertebrae was T1. Fifty-six percent of cases were associated with a syndrome, the most common being spondylocostal dysostosis. The presence of multiple butterfly vertebra was strongly associated with a syndrome or additional anomalies (P < .001). Overall, the most common presenting complaint was low back pain. Seventy percent of patients had associated spinal disease. Other organ systems affected included musculoskeletal (43%), craniofacial (30%), neurologic (27%), cardiovascular (24%), genitourinary (23%), gastrointestinal (22%), laboratory abnormality (16%), and endocrine (9%).

CONCLUSIONS

This study is the largest collection of butterfly vertebrae cases to date. Butterfly vertebrae are associated with spinal deformity and multiple butterfly vertebrae may indicate a syndromic illness. Low back pain or disc herniation may occur with lumbar butterfly vertebrae however the etiology of this phenomena has not been rigorously explained. Many diseases and syndromes are associated with butterfly vertebrae.

Occipitocervical Osteotomies and Interfacet Grafts for Reduction of Occipitocervical Kyphosis and Basilar Invagination

BACKGROUND

Occipitocervical congenital pathologies involving instability of the atlantoaxial joint and basilar invagination are challenging to treat owing to the complex anatomy involving neurovascular structures at the skull base and the high-risk nature of surgery close to the brainstem.

CASE DESCRIPTION

A patient presented with Alagille syndrome with multiple segmentation/fusion anomalies of the cervical spine and craniocervical junction, including fusion of the skull base and occipital condyles and partial assimilation of the C1 anterior ring and C2 dens. The head was anteriorly displaced, with C2 located immediately below the foramen magnum. There was significant kyphotic angulation due to nonunion of the base of the dens and the body of C2. The patient underwent occipitocervical osteotomies and occiput-C2 interfacet grafts for reduction of occipitocervical kyphosis along with foramen magnum decompression and occiput-C6 fusion. The patient had significant neurologic improvement and sustained improved craniocervical alignment on last follow-up.

CONCLUSIONS

In patients with atlantoaxial instability with basilar invagination, posterior facet release, local distraction, and placement of cortical bone interbody grafts with occipitocervical fusion may be instrumental in reducing craniocervical kyphosis and compression by allowing anterior translation of the upper cervical spine relative to the skull. This method may be a safe and effective posterior-only approach for brainstem/spinal cord decompression for patients with complex craniocervical congenital malformations.

Effects of prone trunk extension exercise using different fixations and with and without abdominal drawing-in maneuver in healthy individuals

[Purpose] The purpose of this study was to investigate the differential effects of fixation of the thoracolumbar junction on the activity of the thoracic and lumbar muscle groups with and without the abdominal drawing-in maneuver (ADIM). [Subjects and Methods] The participants were 40 healthy adults. During trunk extension, thoracic and lumbar muscle activities were assessed using surface electromyography when fixing the pelvic and popliteal areas and the thoracolumbar junction, with and without the ADIM. [Results] The activity of the thoracic extensors at the T9 level applying thoracolumbar fixation with ADIM was significantly higher than with only pelvic fixation or pelvic fixation with ADIM during prone trunk extension. However, the activity of the lumbar extensors at the L3 level with pelvic fixation alone, without ADIM, was significantly higher than pelvic fixation with ADIM or additional thoracolumbar fixation with ADIM during prone trunk extension [Conclusion] This study demonstrated that fixation of the thoracolumbar junction with ADIM during trunk extension was more effective at eliciting thoracic extensor and minimising lumbar extensor activity than other conventional fixation methods.

Butterfly vertebra: a case report

Background and importance: Butterfly vertebra is an uncommon congenital spinal anomaly, which can be easily mistaken for vertebral fracture, infection or tumor.

Clinical presentation: We report the case of a 20-year-old male patient with a 3-year history of intermittent mid-thoracic spinal pain. Local examination showed a mild thoracic kyphoscoliosis. Neurological examination was normal. Computer tomography revealed the presence of a T6 butterfly vertebra associated with morphological anomalies in adjacent vertebral bodies and T6-T9 Schmorl’s nodes. MRI scan confirmed the diagnosis and additionally showed a mild spinal stenosis caused by apparent posterior epidural fat hypertrophy. The patient was treated with painkillers and physical therapy.

Conclusion: Butterfly vertebra is a benign condition. Once diagnosed, additional diagnostic procedures are not necessary. Neurosurgeons must be aware of this congenital anomaly that should not be confused with a vertebral fracture.

The effects of sitting with the right leg crossed on the trunk length and pelvic torsion of healthy individuals

[Purpose] The purpose of this study was to determine the effects on the trunk length and pelvic torsion of healthy individuals that arise from crossing the right leg while sitting. [Subjects and Methods] The subjects in this study were 30 healthy individuals consisting of 18 males and 12 females. The subjects were instructed to sit on a chair, the height of which was adjustable, so that their knee and hip joints were bent at 90°. For the study, they sat stripped to the waist, with the back and hips bare. They were then instructed to perform a one-leg-crossed sitting posture by placing the right leg on the top of the left knee. A spinal posture test was performed to measure the subjects’ trunk length and pelvic torsion by using a three-dimensional image-based spinal diagnostic system. [Results] The results of the three-dimensional spine examination showed statistically significant decreases in trunk length and pelvic torsion after the one-leg-crossed sitting posture. [Conclusion] In this study, the right leg-crossed sitting posture led to a decrease in the right trunk length with time and, in terms of pelvic torsion, increased the posterior rotation of the right pelvis when compared with the left pelvis.