Thoracolumbar Anomalies Flashcards

Questions and Answers

What is Hahn's Venous Clef?

A normal finding. Vertebral vascular foramina for the Basivertebral vein. Not to be confused with a fracture. It is a short transverse lucent line in the mid portion of the vertebral body.

Where are Hahn's Venous Cleft usually found?

Most Common in the lower thoracic spine.

Aka for congenital block vertebra?

Congenital synostosis or failure of segmentation.

What is a block vertebra?

Fusion of two or more vertebrae secondary to embryonic failure of somite segmentation. Signup and view all the answers

Main differential considerations for a block vertebra?

Previous infection, trauma, post surgical. Signup and view all the answers

What imaging is useful for detecting associated anomalies with block vertebra?

CT or MRI. Signup and view all the answers

Butterfly vertebra AKA?

Sagittal cleft vertebra. Signup and view all the answers

Where are butterfly vertebra most common?

Thoracolumbar junction. Signup and view all the answers

Characteristic triad of butterfly vertebra?

Two lateral wedge shape halves, midline hourglass shaped sagittal cleft, widened interpediculate distance. Signup and view all the answers

What is a scrambled spine?

Multiple spinal anomalies or a combination of spinal anomalies. Signup and view all the answers

Hemivertebrae aka?

Congenital wedge vertebra. Signup and view all the answers

What is hemivertebra?

Failure of the ossification of part of a vertebral body so only the ossification center appears. Signup and view all the answers

Three types of hemivertebrae?

Lateral, dorsal, ventral. Signup and view all the answers

How do all hemivertebrae appear?

Trapezoidal or triangular appearance. Signup and view all the answers

What view are lateral hemivertebrae best seen on?

AP projection. Signup and view all the answers

Hemivertebra that is fully segmental or free?

Not attached to either vertebra above or below. Most concerning. Signup and view all the answers

Hemivertebra that is non-segmental?

Not separated from either level above or below. Causes less concern. Signup and view all the answers

Hemivertebra that is semi-segmental?

Half segment is fused with vertebra above or below with no intervening IVD. Signup and view all the answers

Hemivertebra that is incarcerated?

Joined by pedicles two levels above and below. Causes less concern. Signup and view all the answers

Dorsal hemivertebra?

Lack of formation of the anterior portion of the vertebral body. Most commonly seen in the lower thoracic. Results in an acute kyphosis (gibbous deformity). Signup and view all the answers

Ventral hemivertebra?

Absence of the posterior half of the vertebral body. Least common form. Signup and view all the answers

What is a coronal cleft vertebra?

Delayed union of the anterior and posterior halves of the vertebral body. Signup and view all the answers

Gender predominance for coronal cleft vertebra?

Males > females. Signup and view all the answers

Where are coronal cleft vertebra most common?

Lumbar spine > thoracic spine. Signup and view all the answers

Clinical significance of coronal cleft vertebra?

None. Signup and view all the answers

What is a Schmorl's node?

Intravertebral body herniation of the nucleus pulposus. Signup and view all the answers

Gender predominance for Schmorl's node?

Males > females. Signup and view all the answers

Most common location for Schmorl's node?

Thoracolumbar junction. Signup and view all the answers

Schmorl's nodes are associated with?

Scheuermann disease. Signup and view all the answers

Scheuermann's Disease aka?

Juvenile kyphosis. Signup and view all the answers

Scheuermann's Disease gender predominance?

Males > females. Signup and view all the answers

Symptoms of Scheuermann's Disease?

Asymptomatic, back pain, severity of symptoms often unrelated to the degree of deformity. Signup and view all the answers

Diagnostic criteria for Scheuermann's Disease?

<ol> <li>Hyperkyphosis: thoracic > 40° and thoracolumbar > 30°. 2. Anterior vertebral body wedging > than 5° in 3 adjacent vertebrae. 3. Disc space narrowing - more pronounced anteriorly. 4. Irregular end plates or multiple Schmorl's nodes.</li> </ol> Signup and view all the answers

What is a limbus bone?

Small triangular well-corticated ossicle permanently separated portion of the vertebral ring epiphysis. Signup and view all the answers

Limbus bone is secondary to?

Peripheral intravertebral disc herniation. Signup and view all the answers

Where are limbus bones typically seen?

At the anterior superior margin of a lumbar segment. Most common at L2-L4. Signup and view all the answers

Clinical significance of limbus bone?

Usually of little or no clinical significance. Signup and view all the answers

Posterior limbus bone gender predominance?

Males > females 4:1. Signup and view all the answers

Posterior limbus bones are most common at?

L4. Signup and view all the answers

Nuclear impression aka?

Notochordal persistency, persistent notochord. Signup and view all the answers

Nuclear impression is characterized by?

Bilateral, parasagittal end plate depressions separated by a centrally placed osseous mound. Signup and view all the answers

Where are nuclear impressions most commonly found?

L5 then L4 then L3. Signup and view all the answers

What is a sign of nuclear impression on a frontal radiograph?

Cupid's bow sign. Signup and view all the answers

What is agenesis of a lumbar pedicle?

Congenital absence of the pedicle or pedicle aplasia. Signup and view all the answers

Most common level for agenesis of a lumbar pedicle?

L4. Signup and view all the answers

Clinically it is important to differentiate agenesis of a lumbar pedicle from what other conditions?

Osteolytic metastasis, neurofibroma, aneurysmal bone cyst, osteoblastoma, etc. Signup and view all the answers

Spina bifida occulta aka?

Spondyloschisis or dysraphism. Signup and view all the answers

What is spina bifida occulta?

Developmental failure of osseous union between the two halves of the posterior arch. Signup and view all the answers

Most common level for spina bifida occulta?

S1, followed by L5, C1, T12-L1. Signup and view all the answers

How does spina bifida occulta appear on a radiograph?

Radiolucent cleft on a frontal radiograph. Signup and view all the answers

Gender predominance for spina bifida occulta?

Male. Signup and view all the answers

Diastematomyelia aka?

Split cord syndrome. Signup and view all the answers

What is diastematomyelia?

Rare spinal dysraphism. Signup and view all the answers

Type I diastematomyelia?

Duplicated dural sac with a midline spur. Signup and view all the answers

Type II diastematomyelia?

Single dural sac containing both hemicords. Signup and view all the answers

Physical findings in diastematomyelia?

Anal dimpling, hairy lumbar patch (fawn's beard), lipomas, asymmetrical extremities. Signup and view all the answers

What imaging is needed to diagnose diastematomyelia?

MR. Signup and view all the answers

What is sacralization?

Assimilation of L5 to the sacrum. Four lumbar vertebrae. Signup and view all the answers

What is lumbarization?

Assimilation of S1 to the lumbar spine. Six lumbar vertebrae. Less common than sacralization. Signup and view all the answers

Berolotti syndrome?

Transitional segment with 'sciatic' pain. Signup and view all the answers

What classification is used in lumbosacral transitional vertebra?

Castellvi classification. Signup and view all the answers

Type I Castellvi classification?

Enlarged and dysplastic transverse process with no obvious connection to the sacral ala; spatulization. Signup and view all the answers

Type II Castellvi classification?

Pseudo articulation of the transverse process and the sacral ala. Signup and view all the answers

Type III Castellvi classification?

Transverse process fuses with the sacrum. Signup and view all the answers

Type IV Castellvi classification?

Type IIa on one side and type IIIa on the other side. Signup and view all the answers

Type A vs. Type B Castellvi classification?

A: unilateral, B: bilateral. Signup and view all the answers

Facet tropism aka?

Asymmetrical facets. Signup and view all the answers

What is facet tropism?

Asymmetrical facets; one mostly oriented in the sagittal plane and one mostly oriented in the coronal plane. Signup and view all the answers

Most common level for facet tropism?

L5-S1 followed by L4-L5. Signup and view all the answers

Agenesis of the articular pillar aka?

Facet joint agenesis. Signup and view all the answers

Most common level for agenesis of the articular pillar?

L4 or L5. Signup and view all the answers

Bilateral agenesis of the articular pillar predisposes a patient for?

Dysplastic spondylolisthesis. Signup and view all the answers

What is an Oppenheimer's ossicle?

Persistent or ununited apophysis at the tip of the superior or inferior articular process. Signup and view all the answers

Most common level for Oppenheimer's ossicle?

L1-L4. Signup and view all the answers

Oppenheimer's ossicle gender predominance?

Males > females 6:1. Signup and view all the answers

Clinical significance of Oppenheimer's ossicle?

None. Must differentiate from fracture. Signup and view all the answers

What is clasp-knife deformity?

A combination of caudal elongation of the L5 spinous process and spina bifida occulta of S1. Signup and view all the answers

What movement may be painful with clasp-knife deformity?

Hyperextension. Signup and view all the answers

Paraglenoid sulci aka?

Preauricular groove. Signup and view all the answers

Where does paraglenoid sulci occur?

Occurs at the insertion of the anterior sacroiliac ligament. Signup and view all the answers

What does the paraglenoid sulci transmit?

Superior branch of the gluteal artery and nerve. Signup and view all the answers

What is a phlebolith?

Concretions representing calcified thrombi attached to the wall of veins. Signup and view all the answers

Where are phleboliths most frequently seen?

Within the pelvic basin below the ischial spines. Signup and view all the answers

Primary differential for phleboliths?

Renal stone. Signup and view all the answers

What are injection granulomas?

Calcified masses seen in the muscles at the side of injections. Represents fat necrosis with subsequent calcification. Signup and view all the answers

Where are injection granulomas most common?

Within the posterior lateral gluteal region. Signup and view all the answers

Study Notes

Thoracolumbar Anomalies and Normal Variants

Hahn's Venous Cleft: Normal finding representing vertebral vascular foramina for the Basivertebral vein; appears as a short transverse lucent line in the mid-portion of the vertebral body.
Location of Hahn's Venous Cleft: Commonly found in the lower thoracic spine.
Congenital Block Vertebra: Also known as congenital synostosis or failure of segmentation; involves fusion of two or more vertebrae due to embryonic failure of somite segmentation.
Main Differential Considerations: Consider previous infection, trauma, or post-surgical changes for block vertebrae.
Imaging for Block Vertebrae: CT or MRI recommended to detect associated anomalies.
Butterfly Vertebra: Also termed sagittal cleft vertebra, most commonly found at the thoracolumbar junction.
Characteristic Triad: Displays two lateral wedge-shaped halves, a midline hourglass sagittal cleft, and widened interpediculate distance.
Scrambled Spine: Refers to multiple spinal anomalies or a mixture of different spinal anomalies.
Hemivertebra: Known as congenital wedge vertebra; results from failure of ossification of part of a vertebral body.
Types of Hemivertebrae: Include lateral (most common), dorsal, and ventral types; all appear trapezoidal or triangular.
Best Seen on Imaging: Lateral hemivertebrae are best visualized on AP projection.
Classification of Hemivertebrae:
- Segmental (free): Not attached to adjacent vertebrae, most concerning.
- Non-segmental: Not separated from adjacent levels, less of a concern.
- Semi-segmental: Half segment fused with adjacent vertebra.
- Incarcerated: Joined by pedicles to levels above and below, less concerning.
Dorsal Hemivertebra: Deficiency in the anterior portion of the vertebral body, commonly resulting in acute kyphosis.
Ventral Hemivertebra: Represents absence of the posterior half, least common type.
Coronal Cleft Vertebra: Characterized by delayed union of anterior and posterior halves, with a male predominance. Commonly found in the lumbar spine.
Schmorl's Node: Defines intravertebral body herniation of the nucleus pulposus, predominantly affects males, often located at the thoracolumbar junction, and associated with Scheuermann disease.
Scheuermann's Disease: Also referred to as juvenile kyphosis; characterized by asymptomatic cases but can present with back pain unrelated to deformity severity.
Diagnostic Criteria for Scheuermann's Disease: Includes hyperkyphosis (>40° thoracic), anterior vertebral body wedging (>5° in three adjacent vertebrae), and irregular end plates or multiple Schmorl's nodes.
Limbus Bone: Small well-corticated ossicle, typically found anteriorly at lumbar segments L2-L4, often secondary to peripheral intravertebral disc herniation with minimal clinical significance.
Nuclear Impression: Identified by parasagittal end plate depressions with osseous mound, occurrence primarily at L5, characterized by the "Cupid's bow" sign on frontal radiographs.
Agenesis of a Lumbar Pedicle: Congenital absence usually at L4, important to differentiate from conditions like osteolytic metastasis.
Spina Bifida Occulta: Developmental failure of osseous union, most commonly seen at S1, followed by L5 and C1, often presenting as a radiolucent cleft on X-rays.
Diastematomyelia: Rare dysraphism with two types: Type I (duplicated dural sac with midline spur) and Type II (single dural sac with both hemicords).
Sacralization: Assimilation of L5 to the sacrum, results in four lumbar vertebrae; lumbarization refers to S1 assimilating into the lumbar spine, leading to six lumbar vertebrae.
Berolotti Syndrome: Defined by the presence of transitional segment causing sciatic pain.
Castellvi Classification: Used for lumbosacral transitional vertebra; includes Type I (enlarged transverse process), Type II (pseudo articulation), Type III (fused transverse process), and Type IV (mixed types).
Facet Tropism: Asymmetrical facets, primarily seen at L5-S1, increasing the risk for conditions like dysplastic spondylolisthesis due to bilateral agenesis of the articular pillar.
Oppenheimer's Ossicle: Persistent or ununited apophysis at the tip of the superior or inferior facets, most commonly observed at L1-L4 with a male predominance.
Clasp-Knife Deformity: Combination of elongated L5 spinous process and spina bifida occulta at S1; hyperextension may cause pain.
Paraglenoid Sulci: Preauricular grooves at the anterior sacroiliac ligament insertion, transmitting the superior branch of the gluteal artery and nerve.
Phlebolith: Calcified thrombi found in veins, significantly seen within the pelvic basin.
Injection Granulomas: Calcified masses in muscles post-injection, primarily observed in the posterior lateral gluteal region.

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Test your knowledge on thoracolumbar anomalies and normal variants with these flashcards. Each card highlights critical definitions and key locations related to these anatomical features, offering insights into normal findings such as Hahn's Venous cleft and congenital block vertebrae.