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RadloGraphics index terms: Musculoskeletai Imaging SPINE The vertebral body: Cumulative Index terms: Spine,
RadloGraphics
index
terms:
Musculoskeletai
Imaging
SPINE
The
vertebral
body:
Cumulative
Index
terms:
Spine,
abnormalities
Radiographic configurations
in various
congenital
and
acquired disorders
Rajendra
Kumar,
M.D.’
Faustino
C.
Guinto,
Jr.,
M.D.’
John
E. Madewell,
0 TH
fr
M.D.t
Leonard
E. Swischuk,
M.D.’
Ruppert
David,
M.D.t
.tlons
are disease-
In uI7
III’.lI
V I
I
1
WJlI W
specific and when recognized on radiographs,
correct diagnosis possible.
make
THIS EXHIBIT WAS
DISPLAYED
AT
THE 73RD
SCIENTIFIC
ASSEMBLY
Introduction
AND
ANNUAL
MEETING
OF
THE RA-
DIOLOGICAL
SOCIETY
OF
NORTH
A normal
vertebra
has
a body
(centrum)
and
posterior
elements.
AMERICA.
NOVEMBER
29-DECEM-
BER 4.
1987.
CHICAGO.
ILLINOIS.
IT
The
body
has
a distinct
shape
and
appears
rectangular
on
WAS
RECOMMENDED
BY THE MUS-
radiographs.
Its height
tends
to be somewhat
less than
its width.
CULOSKELETAL
AND
PEDIATRIC
IM-
Many intrinsic
and
extrinsic
disease
processes
may
alter
this normal
AGING
PANELS
AND
WAS
AC-
vertebral
body
configuration.
Such disorders
may
be congenital
or
CEPTED
FOR
PUBLICATION
AFTER
acquired,
often
imparting
specific
shapes
to
the
body
(Table
I).
A
PEER
REVIEW
ON
MARCH
7.
1988.
knowledge
of such
abnormal
vertebral
body
configurations
may
aid
in the
diagnosis
of
an
underlying
disorder.
The body
of a vertebra
is composed
of canceilous
tissue
covered
by
a thin
layer
of compact
bone,
and
contains
numerous
blood
vessels.
The trabeculae
of the
vertebra
are more
pronounced
in the
vertical
than
in the
horizontal
direction
in response
to greater
From
the
Departments
of
Radiology,
University
of Texas
stress along
the
cephalocaudal
axis. Slight
concavity
normally
Medical
Branch,
Galveston
characterizes
all
the
surfaces
of
the
vertebral
body.
and
Baylor
College
of
(a),
Medicine
(t),
Houston,
Texas.
Address
to P. Kumar,
reprint
requests
M.D., Depart-
ment of Radiology, University
of Texas Medical Branch, Gal-
veston, TX 77550.
Volume
8, Number
3
1988
#{149}RadioGraphlcs
455
#{149}May,

The vertebral

body:

Acquired

and

congenital

disorders

Kumar

et

al.

Table I Classification Configurations of the of the Abnormal Body of a Vertebra Congenital Acquired
Table
I
Classification
Configurations
of the
of the Abnormal
Body of a Vertebra
Congenital
Acquired
A.
Asomia (agenesis)
A.
Abnormal size
B. Hemiventebra
1 . Small vertebral body
C. Coronal cleft
2. Enlarged vertebral body
D.
Butterfly vertebra
B.
Bonder abnormalities
E. Block vertebra
1. Anterior border scalloping
F. Hypoplasia
2. Posterior
border
scalloping
3. Lateral border scalloping
4. Anterior
border
straightening
5. Endplate deformities
C. Vertebral
tongues,
spurs
and
beaks
D. Miscellaneous body shapes
 

Embryologic

Considerations

 

The body

develops

from

the

curs.

The portions

of

the

notochord

inconporat-

cells

of

the

of a vertebra sclenotome,

a derivative

of

the

no-

ed

within

the

body

undergo

atrophy

and

dis-

tochord.

Two

ossification

 

centers,

one

for

the

appear.

Those

which

lie within

the

intenverte-

ventral

and

the

other

for the

dorsal

half

of

the

bral

discs

enlarge

and

persist

as the

nuclei

body,

appear

by

the

9th

gestational

week.

Os-

pulposi.

 

sification

of these

centers

is complete

 

by

the

Any

deviation

in the

normal

development

12th

week.

These

centers

soon

fuse

to

form

a

of

the

body

of a vertebra

leads

to

many

con-

single

large

center

which

later

divides

the

genital

anomalies

in its configuration,

as illus-

body

of

the

future

vertebra

into

two

thick

 

trated

in Figure

1.

plates

where

endochondral

ossification

oc-

 
I I I I I eee s- i r ia himi ii1 i#{149}I - *
I
I
I
I
I
eee
s-
i r ia
himi ii1 i#{149}I
-
*
.
II

Figure 1

Schematic

drawing

depicting

the development

of

456 RadioGraphics

normal

#{149}May,

and abnormal

1988

#{149}Volume

vertebral

bodies.

8, Number

3

Kumar et al. The vertebral body: Acquired and congenital disorders Vertebral Body Configurations Congenital
Kumar
et
al.
The vertebral
body:
Acquired
and
congenital
disorders
Vertebral
Body
Configurations
Congenital
Developmental
deformity
of
the
body
associated
with
congenital
anomalies
of
the
of a vertebra
genitouninany,
is often
gastrointestinal,
and
central
nervous
systems.
A.
Asomia
(A genesis)
B. Hemivertebra
Complete
absence
of
the
body
of
a verte-
Unilateral
wedge
vertebra
is due
to
lack
of
bra
may
occur
despite
the
presence
of
the
ossification
of
one-half
of
the
body.
A
right
on
posterior
elements
(Figure
2).
This anomaly
ne-
left
hemivertebra
may
thus
occur.
The
hemiver-
suIts
from
failure
of
ossification
centers
of
the
tebra
assumes
a wedge-shaped
configuration
body
to
appear.
One
on more
vertebral
seg-
with
the
apex
of
the
wedge
reaching
the
mid-
ments
may
be
involved.
plane
(Figure
3).
Scoliosis
is often
present
at
birth.
Figure 2
Figure 3
Asomia
Congenital
absence
of the
body of
Left hemivertebra
involving
Ti
1
L2
Hypoplastic
posterior
elements
are present
(an-
now).
Volume
8, Number
3
1988
#{149}RadioGraphics
457
#{149}May,

The

vertebral

 

body:

Acquired

and

congenital

 

disorders

 

Kumar

et

al.

Dorsal

and

ventral

 

hemivertebrae

 

occur

Hemivertebra

secondary

to

hemimetame-

because

 

of

failure

of

the

ventral

or dorsal

half

tric

segmental displacement

or

persistence

 

of

of

the

vertebral

body

to

ossify

(Figure

4).

The

the

night

and

left

halves

of

the

vertebral

body

failure

of

ossification

is believed

to

be

second-

 

leads

to

the

hemiventebnae

being

separated

 

any to ischemia

during

the

developmental

stage.

from

each

other

in the

sagittal

plane.

One

such

A

kyphotic

 

defonmity

is seen

at

the

site

of

a

hemivertebra

 

may

fuse

with

the

body

of

a yen-

dorsal

hemivertebra.

 

A ventral

hemivertebra

is

tebnal

segment

above

or

below

the

affected

 

extremely

 

rare

and

results

from

failure

of

ossifi-

segment

(Figure

5).

cation

of

the

dorsal

half

of

the

vertebral

body.

 
t: ’ &
t: ’
&

Figure 4

Dorsal hemivertebra

involving

Li

Metametric hemivertebrae in the

lower

lumbar

spine

458 RadloGraphics

#{149}May,

1988

#{149}Volume

with

“mermaid”

8, Number

3

deformity

of the lower

extremities.

Kumar et al. The vertebral body: Acquired and congenital disorders C. Coronal Cleft D. Butterfly
Kumar
et
al.
The vertebral
body:
Acquired
and
congenital
disorders
C.
Coronal
Cleft
D.
Butterfly
Vertebra
(Sagittal
Cleft
Vertebra)
This anomaly
results
from
a failure
of
fusion
of
the
anterior
and
posterior
ossification
cen-
Butterfly
vertebrae
result
from
the
failure
of
tens
which
remain
separated
by
a
cartilage
fusion
of
the
lateral
halves
of
the
vertebral
plate.
It represents
a delay
in normal
vertebral
body
because
of
persistent
notochondal
tissue
maturation;
in most
cases
clefts
disappear
by
between
them.
The
involved
vertebral
body
is
six months
after
birth.
Coronal
clefts
are
usually
widened,
and
the
bodies
above
and
below
the
seen
in
the
lower
thonacic
on lumbar
vertebral
butterfly
vertebra
adapt
to
the
altered
inter-
bodies.
The
deformity
is most
often
seen
in pre-
vertebral
discs
on
either
side
by
showing
con-
mature
male
infants
and
can
be
recognized
in
cavities
along
the
adjacent
endplates
(Figure
utero.
Cleft
vertebrae
may
also
occur
in infants
7).
Some
bone
bridging
may
occur
across
the
with
chondrodystrophia
calcificans
congenita.
defect
which
is usually
seen
in
the
thoracic
on
Radiognaphically,
a vertical
radiolucent
band
is
lumbar
segments
of
the
spine.
Anterior
spina
seen
just
behind
the
midportion
of the
body
on
bifida,
with
on without
anterior
meninogocele,
the
latenial
view
of
the
spine
(Figure
6).
may
be
associated
with
a butterfly
vertebra.
Figure 6
Vertebrae
with coronal clefts are seen on this later-
Figure 7
al view of the thonacolumban
spine.
“Butterfly”
vertebra
involving
L4
Volume
8, Number
3
1988
#{149}RadioGraphics
459
#{149}May,

The vertebral

body:

Acquired

and

congenital

disorders

 

Kumar

et

al.

E. Block

Vertebra

 

vertebral

fusion,

this dimension

 

is less than

in the

is often

 

(Congenital

Vertebral

Fusion)

 

case

of

congenital

 

fusion.

A

“waist”

 

seen

at

the

level

of

the

intervertebral

disc

be-

 

This congenital

abnormality

is due

to

a fail-

tween

the

fused

segments

(Figure

8A).

This

ure

in the

process

of segmentation

during

fetal

finding

is usually

absent

in

an

acquired

verte-

life.

The fusion

may

be

complete

(both

anterior

 

bral

fusion

(Figure

8B). The intervertebral

fonam-

and

posterior

elements

involved),

or

partial.

ma

of block

vertebrae

 

become

ovoid

and

nar-

The

height

of

fused

bodies

equals

the

sum

of

rowed.

Congenital

 

vertebral

 

fusion

usually

the

heights

of

the

involved

bodies

and

the

in-

occurs

in the

lumbar

and

cervical

segments.

 

tervertebral

discs

between

them.

In acquired

 
discs between them. In acquired   Figure 8 (A) CS Block vertebra with congenital of a
discs between them. In acquired   Figure 8 (A) CS Block vertebra with congenital of a

Figure 8

(A)

CS

Block vertebra

with congenital

of a “waist”

Note the presence

fusion

of

C4 and

at the

site

of

 

fusion

(arrow).

(B) Acquired

vertebral

body fusion

of CS and

C6.

 

460

RadioGraphics

#{149}May,

1988

#{149}Volume

8, Number

3

Kumar et al. The vertebral body: Acquired and congenital disorders F. Hypoplastic Vertebra This anomaly
Kumar
et
al.
The vertebral
body:
Acquired
and
congenital
disorders
F. Hypoplastic
Vertebra
This anomaly
is usually
the
result
of
vascular
insufficiency
during
fetal
life.
It may
affect
one
on more
vertebrae
(Figure
9).
Congenital
hypoplastic
L4 vertebral
body
Volume
8, Number
3
1988
#{149}RadioGraphics
461
#{149}May,

The vertebral

body:

Acquired

and

congenital

disorders

 

Kumar

et

al.

 

Vertebral

Body

Configurations

 
 

Acquired

 
 

Vertebral

 

body

abnormalities

resulting

from

trauma,

infection,

 

and

neoplasm

are

excluded

from

this discussion.

 

A.

ABNORMAL

SIZE

dependent

and,

in

general,

does

not

occur

 

with

doses

of

less than

1000

rads.

Unilateral

radi-

 

An abnormality

 

in the

size

is

ation

may

cause

scoliosis

because

of

unequal

 

most

often

due

to

a compression

of a vertebra deformity

of

growth

of

the

affected

bodies,

the

concavity

the

body.

Certain

diseases,

however,

may

af-

of

the

scoliosis

occurring

on

the

irradiated

side.

fect

the

normal

vertebral

growth

resulting

in al-

Osteoporosis

 

and

vertebral

collapse

may

be

tened

size.

seen

in adults

following

irradiation.

 
 

Juvenile

 

rheumatoid

arthritis

causes

 

re-

 

1. Small

Vertebral

Body

 

duced

vertebral

 

growth

because

of

early

epi-

 

physeal

closure;

this

results

in small

vertebrae

 
 

Radiation-induced

 

vertebral

hypoplasia

(Figure

11).

Vertebral

fusion

may

also

occur.

may

result

from

irradiation

 

of

the

spine

during

The

cenvical

 

spine

is most

often

involved,

and

early

childhood

(Figure

10).

The

effect

is dose-

atlantoaxial

subluxation

may

be

present.

dose- atlantoaxial subluxation may be present. Figure 10 The left sided hypoplasia seen here is due

Figure 10 The left sided hypoplasia

seen here is due to unilateral irradiation of the lum-

bar spine for retnopenitoneal hemangioma during childhood. Note the hypoplastic left kidney.

of the vertebral

bodies

462 RadioGraphics

#{149}May,

1988

#{149}Volume

bodies 462 RadioGraphics #{149} May, 1988 #{149} Volume Figure 11 Juvenile rheumatoid arthritis with hypoplastic

Figure 11 Juvenile rheumatoid arthritis with hypoplastic cenvi- cal vertebral bodies Note the posterior vertebral fu- sion.

8, Number

3

Kumar et ai. The vertebral body: Acquired and congenital disorders Eosinophilic granuloma causes a marked
Kumar
et
ai.
The vertebral
body:
Acquired
and
congenital
disorders
Eosinophilic
granuloma
causes
a
marked
Gaucher’s
disease
is characterized
by
the
compression
deformity,
and
may
lead
to
a
deposit
of
glucocerebrosides
within
the
neticu-
“vertebra
plana”
deformity
(Figure
12).
Lesser
loendothelial
cells
of
the
vertebral
body.
This
compression
deformities
are
more
frequent,
causes
weakening
and
compression
deformity
however.
The
lumbar
and
lower
thoracic
par-
similar
to
that
seen
in osteoporosis
(Figure
13).
tions
of
the
spine
are
most
often
involved.
This is
a self-limiting
disease.
The vertebra
may
regain
“normal”
shape
after
many
years,
with
or with-
out
treatment.
Figure 13
Gaucher’s disease with osteoporosis and compres-
sion deformities of vertebral bodies
Volume
8, Number
3
1988
#{149}RadioGraphics
463
#{149}May,

The vertebral

body:

Acquired

and

congenital

disorders

 

Kumar

et

al.

 

Platyspondyly

generalizata

is a nonspecific

 

tebral

bodies

have

been

described

in achon-

descriptive

term

applied

to

the

many

heredi-

droplasia,

spondyloepiphyseal

dysplasia

tarda

tary

systemic

diseases

that

are

associated

 

with

(Figure

14),

mucopolysacchanidosis,

osteope-

 

flattened

vertebral

bodies.

Though

vertebral

trosis,

neurofibromatosis,

 

osteogenesis

imper-

bodies

are

flat,

the

discs

tend

to

be

of

normal

fecta

(Figure

15),

and

many

others.

height.

Dwarfism

and

numerous

spinal

curva-

 

tune

deformities

may

be

present.

Such

flat

yen-

Figure 15 Figure 14 Osteogenesis imperfecta tarda with osteoporosis Platyspondyly in spondyloepiphyseal dysplasia
Figure 15
Figure 14
Osteogenesis
imperfecta
tarda with osteoporosis
Platyspondyly
in spondyloepiphyseal
dysplasia
tanda
and compression
deformities
of vertebral
bodies

464 RadloGraphics

#{149}May,

1988

#{149}Volume

8, Number

3

Kumar et ai. The vertebral body: Acquired and congenital disorders Thanatophoric dwarfism results in extreme
Kumar
et
ai.
The vertebral
body:
Acquired
and
congenital
disorders
Thanatophoric
dwarfism
results
in extreme
flattening
of
the
hypoplastic
vertebral
bodies
(Figure
bA).
An
“H”
on “U”
configuration
of
the
vertebral
bodies
is seen
in
the
anteropostenion
view
(Figure
loB).
16A
Volume
8, Number
3
1988
#{149}RadloGraphics
465
#{149}May,

The vertebral

body:

Acquired

and

congenital

disorders

 

Kumar

et

al.

 

2.

Enlarged

Vertebral

Body

Gigantism

 

may

cause

an

increase

in

the

 

height

of vertebral

bodies

(Figure

18).

The inter-

 

Paget’s

disease

causes

 

enlargement

of

the

vertebral

discs

may

show

a similar

change.

 

vertebral

body

in

all

dimensions

unless

compli-

Myositis

 

ossificans

progressiva

 

produces

 

cated

by

a compression

fracture.

A “picture-

vertebral

bodies

that

are

tall,

being

greaten

in

frame”

appearance

 

may

be

imparted

to

the

height

than

in width

(Figure

19).

Associated

 

os-

body

in

the

mixed

phase

of

the

disease

(Figure

teoponosis

may

ultimately

lead

to

compression

17).

The

body

alone

 

on the

entire

vertebra

may

deformity

of

the

vertebral

bodies.

 

be

involved

and

often

appears

sclerotic.

 
 

Figure 17 Paget’s disease showing

enlargement

of the

L3 yen-

 

tebnal body

with the “picture-frame”

vertebra

ap-

 

peanance

 
Figure 19  
Figure 19  
Figure 19

Figure 19

 

Myositis ossificans

progressiva with

“tall

but slim” vertebrae in the cervical spine Note the ossification of the ligamentum nuchae (arrowhead).

 

Figure 18

Gigantism with

“tall”

vertebral

bodies

in the cervical

 

spine

466 RadioGraphics

 

#{149}May,

1988

#{149}Volume

8, Number

3

Kumar et ai. The vertebral body: Acquired and congenital disorders B. BORDER ABNORMALITIES Any border
Kumar
et
ai.
The vertebral
body:
Acquired
and
congenital
disorders
B. BORDER
ABNORMALITIES
Any
border
of a vertebral
body,
including
the
end
plates,
may
be
affected.
1. Anterior
Border
Scalloping
cent
vertebral
body
(Figures
20A
and
B).
The
defect
has
a sclerotic
margin,
consistent
with
Aortic
aneurysm
because
of
its
pulsatile
the
chronicity
of
the
process.
The
lower
thonac-
pressure
may
cause
a
concave
compression
ic
and
upper
lumbar
vertebral
segments
are
defect
along
the
anterior
surface
of
an
adja-
most
often
involved.
20A
Figure 20
(A) This lateral tomognam of the lumbar spine shows anterior verte-
bnal notching (arrows) of L2
and
L3. (B)
A CT section
through
L3
shows that the anterior vertebral notching is caused by a large ab-
dominal aortic aneurysm.
langed aorta in the center
Note the contrast
and the calcification
enhanced
lumen
of the
en-
in the wall
of the
aneu-
rysm. (Courtesy of N. Patel, M.D., Newburgh, NY.)
Volume
8, Number
3
1988
#{149}RadioGraphics
467
#{149}May,

The

vertebral

body:

Acquired

and

congenital

disorders

Kumar

#{149}tal.

2.

Posterior

Border

Scalloping

 

Neurofibroma

tosis

is

assoc

iated

with

 

marked

scalloping

of

the

posterior

bonders

of

 

Normal

posterior

scalloping

 

may

occur

as

the

vertebral

bodies

caused

by dunal

ectasia

on

a

rare

variant.

In contrast

to

the

concave

de-

intnaspinal

tumors

(Figures

22A

and

B). Widen-

fect

seen

with

other

disorders,

the

posterior

ing

of

the

intervertebral

fonamina

may

be

seen.

scalloping

that

represents

a

normal

variant

is

Any

spinal

segment

may

be

involved,

and

scoli-

characterized

by

an

angular

defect

with

its

osis and

kyphoscoliosis

may

be

present.

Rarely,

apex

pointing

anteriorly

(Figure

21).

anterior

 

bonder

scalloping

may

be seen

in neun-

  bonder scalloping may be seen in neun- Figure 21 Normal posterior vertebral notching in the

Figure 21 Normal posterior vertebral notching in the lumbar spine

ofibromatosis.

vertebral notching in the lumbar spine ofibromatosis.   22A   Figure 22 (A) Neurofibromatosis
 

22A

 

Figure 22 (A) Neurofibromatosis with posterior vertebral

 
 

lumbar

spine

(B)

A myelognam

 

notching in the shows that the dural ectasia.

vertebral

notching is secondary

to

468

RadioGraphlcs

#{149}May,

1988

#{149}Volume

8, Number

3

Kumar et al. The vertebral body: Acquired and congenital disorders In achondroplasia, posterior indentation of
Kumar
et
al.
The vertebral
body:
Acquired
and
congenital
disorders
In achondroplasia,
posterior
indentation
of
In acromegaly,
scalloping
is often
present
the
vertebral
bodies
may
be
present
owing
to
a
along
the
posterior
aspect
of lumbar
vertebrae
developmental
defect
(Figure
23).
Platyspon-
(Figure
24),
and
the
antenopostenior
diameter
dyly
is often
seen.
Disc
henniations
with
marked
of
the
bodies
may
be
increased
in the
thonacic
spondylosis
defonmans
are
frequently
seen
in
spine.
Diffuse
osteoporosis
is common
with
olden
patients.
compression
deformities
of
the
vertebral
bod-
ies.
Marked
spondylosis
defonmans
may
be
present.
‘I
--
Figure 23
Achondroplasla with posterior vertebral notching in
the thonacolumbar spine
Figure 24
Acromegaly
with
posterior
vertebral
notching
in the
lumbar
spine
Volume
8, Number
3
1988
#{149}RadloGraphics
469
#{149}May,

The vertebral

body:

Acquired

and

congenital

disorders

Kumar

et

al.

 

Ependymoma

(‘Dog

Spine”)

usually

onigi-

Posterior

meningocele

(Spina

bifida

cys-

nates

in the

filum

terminale

and

produces

scal-

tica)

most

often

occurs

in

the

lumbar

and

sa-

loping

along

the

posterior

borders

of lumbar

cral

regions.

Posterior

concave

vertebral

inden-

vertebral

bodies

 

(Figure

25).

Rarely,

the

lower

tations

occur

as

a result

of

compression

by

the

thoracic

vertebrae

may

be

involved.

There

is

meningocele

 

(Figure

26).

Widening

of

the

spi-

also

widening

of

the

spinal

canal

with

thinning

nal

canal

with

spreading

and

thinning

of verte-

and

spreading

of

the

vertebral

pedicles

(any

bral

pedicles

is also

seen,

and

spina

bifida

and

large

intraspinal

tumor

on dural

ectasia

can

other

congenital

vertebral

 

anomalies

are

often

produce

similar

defects).

 

present.

Both

posterior

and

anterior

meningo-

 

celes

may

occur

in neurofibromatosis.

  celes may occur in neurofibromatosis. Figure 25 Figure 26 Ependymoma with posterior
  celes may occur in neurofibromatosis. Figure 25 Figure 26 Ependymoma with posterior

Figure 25

Figure 26

Ependymoma with posterior vertebral notching in

Meningocele

with

posterior

vertebral

notching

in the

lumbar vertebral bodies (“Dog spine”)

mid thonacic

spine (arrows)

 

470 RadioGraphics

#{149}May,

1988

#{149}Volume

8, Number

3

Kumar

et

aI.

The vertebral

body:

Acquired

 

and

congenital

disorders

 

3.

Lateral

Border

Scalloping

 

4.

Anterior

Border

Straightening

Any

benign

mass

that

lies

in close

proximity

 

Ankylosing

spondylitis

 

produces

 

a “square”

 

to

either

side

of

the

vertebral

column

may

on “box-like’

vertebral

body

configuration

 

in

cause

indentations

along

the

lateral

bonders

of

the

early

stages

 

of

the

disease,

 

owing

to

vertebral

bodies.

This

may

be

seen

in neurofi-

straightening

of

the

anterior

border

(Figure

28).

bromatosis,

 

for example

(Figure

27).

This,

in turn,

is the

result

of

bone

erosions

 

at

the

 

anterior

corners

of

the

body

resulting

 

in

loss

of

the

normal

concavity

of

the

anterior

vertebral

surface.

This finding

is best

seen

in

the

lumbar

spine.

 
is best seen in the lumbar spine.   Figure 27 Neurofibromatosis Vertebral notching caused by

Figure 27 Neurofibromatosis Vertebral notching caused by neunofibnomas is seen along the night lateral bonders in the thonacic spine.

seen along the night lateral bonders in the thonacic spine. Figure 28 Ankylosing spondyiltis with straightening

Figure 28 Ankylosing spondyiltis with straightening

tenon bonders of the lumbar vertebral bodies

of the

an-

Volume

8, Number

3

#{149}May,

1988

#{149}RadloGraphics

47

1

The vertebral

body:

Acquired

and

congenital

disorders

Kumar

et

al.

 

5.

Endplate

Abnormalities

 

Osteoporosis

occurs

in many

disorders

and

results

in weakening

and

collapse

of

the

vente-

bral

body.

It

is often

seen

in postmenopausal

women.

Compression

deformity

of

one

on more

vertebral

bodies

may

occur

with

decrease

in

the

vertebral

height,

and

ultimately

wedge-

shaped,

flat

on biconcave

vertebral

bodies

(“fish

vertebra”)

may

result

(Figures

29A

and

B).

may result (Figures 29A and B). 29A Figure 29 Osteoporosis (A) “Fish-vertebrae” with

29A

may result (Figures 29A and B). 29A Figure 29 Osteoporosis (A) “Fish-vertebrae” with

Figure 29 Osteoporosis (A) “Fish-vertebrae” with biconcave deformities of lumbar vertebral bodies (B) Normal spine of a fish showing biconcave vertebrae

472 RadioGraphlcs

#{149}May,

1988

#{149}Volume

8, Number

3

Kumar et al. The vertebral body: Acquired and congenital disorders Steroid-induced osteoporosis occurring in
Kumar
et
al.
The vertebral
body:
Acquired
and
congenital
disorders
Steroid-induced
osteoporosis
occurring
in
Sickle
cell
disease
causes
a step-like
cen-
patients
who
have
Cushing’s
syndrome
or who
tral
depression
of
the
vertebral
endplates
that
are
on exogenous
steroid
therapy
is a general-
results
in
the
appearance
of
an
“H
vertebra”
ized
process.
In
the
spine,
compressed
verte-
(Figure
31).
Compression
of
the
central
portions
bral
bodies
resulting
from
the
osteoporosis
may
of
the
endplates
occurs
because
of
subchon-
show
bone
condensation
along
the
superior
dral
bone
infancts
in
the
vertebral
body.
The
and
inferior
endplates
(Figure
30),
a feature
in-
body,
because
of
infarction,
is usually
nonho-
frequently
seen
with
compressed
osteoporotic
mogeneous
in appearance.
The
integrity
of the
vertebrae
resulting
from
other
causes.
peripheral
endplates
is believed
to
be
pre-
served
by
a
collateral
blood
supply.
The
disc
spaces
may
be
narrowed.
Similar
step
deformi-
ties
may
also
be seen
in mixed
hemoglobinopa-
thies.
Figure 30
Figure
31
Steroid induced osteoporosis
with vertebral
com-
Sickle cell anemia with “step-off”
deformity
of yen-
pression deformities
Note the increased
sclerosis
subjacent
to the deformed
superior
endplates.
tebral endplates (“H” vertebra) in the thoracic
spine
Volume
8, Number
3
1988
#{149}RadloGraphics
473
#{149}May,

The vertebral

body:

Acquired

A Schmorl’s

node

is a contour

plate

of

a vertebra

resulting

ation

of

a portion

of

the

disc

vertebral

body

(Figures

32A

weakness

in

the

endplate

henniation.

A Schmorl’s

 

node

lucent

defect

with

a sclerotic

to

the

vertebral

endplate.

 

and

congenital

defect

in the

from

central

 

into

the

and

B). A defect

leads

to

such

is seen

as

a

margin

 

end-

herni-

adjacent

or

disc

radio-

subjacent

disorders

Kumar

et

al.

! . 1
!
.
1

Figure 32 (A) Schmorl’s nodes deforming lumbar vertebral

endplates

(B)

This photomicrograph

shows cen-

tnal herniation

of the nucleus

pulposus

into the ad-

joining

vertebra,

resulting

in a Schmorl’s

node for-

motion.

D =

disc;

N

nucleus

pulposus;

V

vertebral

body

 

32A

- . & N ‘V ‘ a #{149},. r a4 . . , . .
-
.
&
N
‘V
a
#{149},.
r
a4
.
.
,
.
.
.
.
%
j %
.
.
h,-,
-.
V
V

474 RadioGraphics

#{149}May,

32B

1988

#{149}Volume

8, Number

3

Kumar et al. The vertebral body: Acquired and congenital disorders A limbus vertebra represents a
Kumar
et
al.
The vertebral
body:
Acquired
and
congenital
disorders
A limbus
vertebra
represents
a distinct
type
A
“ring”
epiphysis
is
a
cartilaginous
ring
of
disc
henniation
in which
there
is intnaosseous
around
the
superior
and
inferior
margins
of
a
penetration
of
disc
material
at
the
junction
of
vertebral
body.
They
represent
a
normal
as-
the
endplate
with
the
vertical
bony
rim
of
a
pect
of
the
development
of
a vertebra,
and
vertebral
body.
An
oblique
nadiolucent
defect
are
seen
as small,
step-like
recesses
at
the
con-
is seen
coursing
toward
the
outer
surface
of
the
ners
of
the
anterior
edges
of vertebral
bodies
in
vertebral
body
which
separates
a
small
seg-
patients
6
to
9 years
of
age
(Figure
34).
Later,
ment
of
the
bone
(Figure
33).
It most
often
oc-
the
entire
ring
may
calcify.
The fusion
of
the
ring
curs
at
the
antenosupenion
corner
of
a
single
epiphyses
to
the
vertebral
body
is complete
by
lumbar
vertebra.
12 years
of age.
Figure 33
Limbus vertebra Note the nadiolucent defect at the
anterosupenion bonder of L4 (arrow).
Figure 34
Normal “ring”
eplphyses of the thonacic
and lumbar
vertebral
bodies
Volume
8, Number
3
1988
#{149}RadioGraphics
475
#{149}May,

The vertebral

body:

Acquired

and

congenital

disorders

Kumar

et

al.

 

Renal

osteodystrophy

is characterized

by

the

spine.

The

sclerotic

bands

are

believed

 

to

the

presence

of horizontal

bands

of increased

be

due

to condensation

of excessive

osteoid

opacity

subjacent

to

the

endplates

of vente-

adjacent

to

the

endplates.

The

“nugger-jer-

brae.

These

zones

of sclerosis

alternate

wIth

ra-

sey”

appearance

 

is usually

seen

in renal

osteo-

diolucent

bands

through

the

centers

of

the

yen-

dystrophy

(Figure

35),

but

may

occur

in osteo-

tebral

bodies

and

the

radiolucent

disc

spaces,

petnosis

(Figure

30)

and

myelofibnosis.

 

imparting

a “nuggen-jensey”

 

appearance

to

imparting a “nuggen-jensey”   appearance to pearance of the lumbar spine lumbar spine 476

pearance

of the lumbar

spine

lumbar

spine

476

RadioGraphics

#{149}May,

1988

#{149}Volume

8, Number

3

Kumar et al. The vertebral body: Acquired and congenital disorders In osteopetrosis, sclerotic vertebral end-
Kumar
et
al.
The vertebral
body:
Acquired
and
congenital
disorders
In
osteopetrosis,
sclerotic
vertebral
end-
C.
VERTEBRAL
TONGUES,
BEAKS
AND
SPURS
plates
alternate
with
the
radiolucent
regions
of
the
disc
spaces
and
the
midportions
of
the
yen-
Various
bony
projections
may
arise
along
tebnal
bodies,
producing
a
“sandwich”
verte-
the
vertebral
margins.
Some
of these
projec-
bra
on “hamburger”
vertebra
appearance
in
tions
impart
specific
contours
to
vertebral
bod-
children
(Figure
37).
A
“ruggen-jensey”
spine
ies.
may
be
seen
in adults
(Figure
36).
In Hurler’s
syndrome
(Gargoylism),
verte-
bral
bodies
have
a rounded
appearance.
A
mild
kyphotic
curve
is seen
at
the
thoracolum-
ban junction.
The
body
at
the
apex
of
the
ky-
photic
curve
is somewhat
smaller
than
the
adjacent
bodies
and
is deficient
in its antero-
superior
aspect.
As
a
result,
its lower
half
pro-
jects
anteriorly
in a tongue-like
fashion
(Figure
38).
Usually,
it
is the
body
of T12,
LI
or
L2 that
is
involved.
Similar
but
less severe
changes
are
often
seen
in Hunter’s
syndrome.
Figure 38
Hurler’s syndrome with “step-off” deformities along
the anterior margins of the lumbar vertebral bodies
Volume
8, Number
3
1988
#{149}RadioGraphics
477
#{149}May,

The vertebral

body:

Acquired

and

congenital

disorders

Kumar

et

al.

 

In Morquio’s

disease,

the

vertebral

bodies

In hypothyroidism,

 

the

vertebral