📌Butterfly Vertebra: A Commonly Misdiagnosed Congenital Anomaly

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📌Butterfly Vertebra: A Commonly Misdiagnosed Congenital Anomaly

✅ Definition and Pathogenesis

Butterfly vertebra, also known as a sagittal cleft vertebra or anterior rachischisis, is a congenital vertebral anomaly caused by the failure of fusion of the lateral halves of the vertebral body due to the persistence of notochordal tissue. This results in a characteristic midline sagittal cleft, giving the vertebra a "butterfly" appearance on imaging.

 

✅ Plain Radiograph

• Widened vertebral body with a central cleft.
• Adjacent vertebrae show concave endplates due to altered intervertebral disc morphology.
• Possible bony bridging across the cleft, especially in the thoracic and lumbar spine.
• Typically, the posterior elements remain intact, distinguishing it from other vertebral defects.

 

✅CT Scan

• Clearly delineates the sagittal split and asymmetry in vertebral body development.
• Identifies osseous bridging or fusion defects.

 

✅MRI

• Best modality for assessing associated soft tissue abnormalities and spinal cord involvement.
• Demonstrates normal or altered intervertebral disc signal at the level of the anomaly.
• Helps differentiate from fracture, metastases, or infection.

 

✅Clinical and Biomechanical Implications

• Often asymptomatic and found incidentally.
• May alter spinal biomechanics, potentially leading to:
• Associated anomalies include spinal dysraphism, congenital scoliosis, and syndromic disorders such as Jarcho-Levin syndrome and Alagille syndrome.

 

✅ Common Differential Diagnoses

• Compression fracture (check for acute changes and disc height preservation)
• Hemivertebra (typically unilateral rather than midline)
• Lytic metastasis (evaluate for adjacent soft tissue involvement)
• Vertebral osteomyelitis (look for endplate destruction and soft tissue abscesses)

 

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