Spinal Anomalies

Question 1

Hahn Clefts

Answer 1

Vascular Channels

Appears as a horizontal lucency within the VB extending to the posterior VB cortex

Question 2

Nuclear Impression/Notochordal Remnant

Answer 2

Smooth and wide impression on the inferior endplate.
Apex of curve is typically placed posterior
Look for Cupid’s Bow sign on AP Views
Asymptomatic

Question 3

Schmorl’s Node

Answer 3

Abrupt (like a pencil eraser) sclerotic impression on either the superior or inferior endplate
Asymptomatic

Question 4

Anterior Limbus Bone

Answer 4

Small, well corticated bony ossicle at the anterior superior endplate
Asymptomatic

Question 5

Posterior Limbus Bone

Answer 5

Small, well corticated bony ossicle at the posterior inferior endplate or posterior superior endplate
Symptomatic, contraindication to SMT

Question 6

Spina Bifida Occulta/Spondyloschisis Defect

Answer 6

Failure of neural arch fusion and development of SP.
Cervical SP: lack of spinolaminar junction line
Most commonly seen at L5/S1 and transitional zones
Asymptomatic

Question 7

Knife Clasp Deformity

Answer 7

SBO at S1 with enlarged L5 SP

Possibly symptomatic with extension

Question 8

Transitional Lumbosacral Vertebra

Answer 8

Spatulated TVP ( greater than or equal to 19 mm)
Hypoplastic disc
Possible pseudoarticulation with sacral ala

Question 9

Pedicle Agenesis

Answer 9

Congenital absence of a pedicle

Look for sclerosis of the contralateral pedicle

Question 10

Facet Tropism

Answer 10

Facets are in different planes

Most commonly seen at L5S1

Question 11

Congenital Block Vertebra

Answer 11

Failure of somite segmentation
Contraindication to SMT
Key characteristics: 
Anterior VB fusion
Wasp Waist
Hypoplastic Disc
Possible posterior element fusion

Question 12

Butterfly Vertebra

Answer 12

Angled end plates
increased interpediculate distance
enlarged pedicles

Question 13

Hemivertebra

Answer 13

Lateral: Most common, cause of scoliosis
Dorsal: Greater kyphotic curve, symptomatic, ortho consult
Ventral: greater lordotic curve
“incarcerated”: fused to adjacent VB

Question 14

Klippel-Feil Syndrome

Answer 14

Clinical Features:
Short Neck
Low posterior hair line
Decreased cervical ROM

Multiple congenital vertebral anomalies
Sprengel’s deformity association

Question 15

Sprengel’s Deformity

Answer 15

Inferior rotation of scapula and scapular unleveling (2-10 cm)
Possible omovertebral bone: accessory bony ossicle from spine to superior border of scapula

Question 16

Os Odontoidium

Answer 16

Diagnosed after age 7Y
Rounded Anterior tubercle of C1
Free floating bony ossicle above C2 body
No ADI
Contraindication to SMT
DDX: Dens agenesis, dens hypoplasia

Question 17

Ossiculum Terminale

Answer 17

Diagnosed after age 12 Y
accessory ossicle (triangular) above tip of dens

Question 18

Agenesis of C1 Posterior Arch

Answer 18

Missing posterior arch of C1
C2 megaspinous
Wide ADI
Anterior tubercle (C1) hypertrophy
Contraindication to SMT

Question 19

Posterior Ponticle

Answer 19

Forms an arcuate foramen
Associated with headaches
Contraindication to SMT with headache

Question 20

Third Condyle

Answer 20

Accessory ossicle anterior and inferior to the foramen magnum
Possible pseudoarticulation with anterior tubercle (C1) and tip of Dens

Question 21

Paramastoid/Epitransverse Process

Answer 21

Articulation between paracondylar area with C1 TVP

Contraindication to SMT at C0C1

Question 22

Occipitalization

Answer 22

Block vertebra between C0C1
Clinical symptoms:
Headaches
Decreased ROM
Long Neural tract signs

Associated with:
Klippel-Feil Syndrome
Basilar Impression

Contraindication to SMT

Question 23

Nuchal Bones

Answer 23

Sesmoid bones within nuchal ligament

Question 24

Cervical Rib

Answer 24

hypoplastic rib on cervical TVP

Question 25

Scoliosis

Answer 25

Describe:
Shape of Curve (C/S)
Apex of Curve
Location of Curve
Angle of Curve (Cobb's)
Direction of Curve (Convexity)
Rotation (0-4)
Curves greater than 30 in children send for ortho consult
Curves 25-40 Brace
Curves over 50 Surgery