Clin Orthop Surg.  2015 Sep;7(3):406-409. 10.4055/cios.2015.7.3.406.

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

• Karargyris O
• Lampropoulou-Adamidou K
• Morassi LG
• Stathopoulos IP
• Chatziioannou SN
• Pneumaticos SG

• KMID: 2234099
• DOI: http://doi.org/10.4055/cios.2015.7.3.406

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.

Keyword

Butterfly vertebra; Vertebral anomalies; Congenital defect; Congenital anomalies; Congenital malformation

MeSH Terms

Accidental Falls
Adult
Female
Humans
Low Back Pain
Lumbar Vertebrae/*abnormalities/pathology/radiography
Tomography, X-Ray Computed

Figure

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  Fig. 1 X-ray of the lumbar spine. (A) Anteroposterior view showing L4 butterfly vertebra (arrow). (B) Lateral X-ray of the lumbar spine, demonstrating anterior wedging of the L4 vertebra (arrow), which can be confused with a compression fracture.

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  Fig. 2 (A) Axial computed tomography (CT) scan of the L4 butterfly vertebra (osseous window). A symmetric cleft-like defect of the L4 body is evident. (B) CT scan, axial view of the L4 butterfly vertebra (soft tissue window).

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  Fig. 3 (A) T2-weighted sagittal magnetic resonance imaging (MRI) of the lumbar spine, clearly showing a central defect in the L4 body, occupied by disc material. (B) Axial T2-weighted MRI of the same L4 butterfly vertebra confirming a symmetrical defect of the vertebral body occupied by disc material. Incidentally, a hemangioma on the left part of the L4 body was noted.

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