Abstract
The term “sagittal cleft vertebra” (SCV) denotes a rare embryologically derived longitudinal defect within the vertebral body, which is clinically and radiologically challenging to diagnose in isolation. This defect results in two hemivertebrae, which ossify discordantly, ultimately leading to a sagittal cleft through the vertebral body. Often presenting with low back pain or concomitant with an associated syndromic illness, SCV is often found incidentally and can mimic vertebral compression fractures radiographically. Treatment of SCV has largely been conservative and symptomatic. With only 109 reported cases in the current literature, we present a unique case of multiple SCV throughout the thoracolumbar region in an adolescent patient. We performed a review of the literature to identify published cases of SCV to date. We searched PUBMED using the terms “sagittal cleft vertebrae”, “butterfly vertebrae”, and “anterior rachischisis”. Abstracts were screened for reports specifically involving original cases of SCV. Given the well-established association with syndromic illnesses, finding an SCV warrants further investigation for other abnormalities of the musculoskeletal, cardiac, and genitourinary systems. Complex management strategies are rare unless the SCV is associated with an aberrant syndrome, disc herniation or severe musculoskeletal abnormality, or symptomatic disc herniation requiring surgical management. Further studies should focus on uncovering the genetic markers leading to the cleft vertebral bodies, with a focus on early screening and monitoring of patients who could be predisposed to the condition.
Similar content being viewed by others
Availability of data and material
Free source, online.
References
Cho HL, Kim JS, Paeng SS, Lee SH (2011) Butterfly vertebra with lumbar intervertebral disc herniation. J Neurosurg Spine 15:567–570. https://doi.org/10.3171/2011.6.SPINE1178
Fischer FJ, Vandemark RE (1945) Sagittal cleft (butterfly) vertebra. JBJS 27:695–698
Kumar R, Guinto FC, Madewell JE, Swischuk LE, David R (1988) The vertebral body: radiographic configurations in various congenital and acquired disorders. Radiographics 8:455–485
Hopkins RM, Jh A (2015) Congenital 'butterfly vertebra' associated with low back pain: a case report. J Man Manip Ther 23:93–100. https://doi.org/10.1179/2042618613Y.0000000057
Kapetanakis S, Giovannopoulou E, Nastoulis E, Demetriou T (2016) Butterfly vertebra. A case report and a short review of the literature. Folia Morphol (Warsz) 75:117–121. https://doi.org/10.5603/FM.a2015.0066
Kaplan KM, Spivak JM, Bendo JA (2004) Embryology of the spine and associated congenital abnormalities. Spine J 5:564–576. https://doi.org/10.1016/j.spinee.2004.10.044
Katsuura Y, Kim HJ (2019) Butterfly vertebrae: a systematic review of the literature and analysis. Global Spine J 9:666–679. https://doi.org/10.1177/2192568218801016
Katsuura Y, Kiner D (2018) Sacral butterfly vertebrae in the setting of a sacral fracture and unstable pelvic ring injury: a case report and review of the literature. Trauma Case Rep 19:7–10. https://doi.org/10.1016/j.tcr.2018.11.011
Le T, Bhushan V, Sochat M, Kallianos K, Chavda Y, Kalani M (2019) First aid for the USMLE step 1 2019: a student-to-student guide. Mcgraw-Hill Education, New York
Swischuk L (2004) Imaging of the newborn, infant, and young child. Lippincott Williams and Wilkins, Philadelphia
Funding
None.
Author information
Authors and Affiliations
Contributions
TZ: project development, manuscript writing. JI: manuscript writing/editing, project development. ASD: manuscript writing/editing. RST: project development, manuscript writing/editing.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to disclose.
Code availability
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zeoli, T., Iwanaga, J., Dumont, A.S. et al. Multi-level sagittally cleft vertebrae: a case report and review of the literature. Surg Radiol Anat 43, 127–130 (2021). https://doi.org/10.1007/s00276-020-02517-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-020-02517-4