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Normal Variants of the Spine

The variants of the spine can be divided by location:

- Vertebral body

- Neural arch

- Spinous process

- Accessory Ossicles


Associations with disease:


- Aicardi sundrome

- Cleidocranial Dysostosis


Vertebral Body Variants:

1. Hemivertebrae: lack of formation of one half of a vertebral body, cause of congenital scoliosis. Acts as a wedge within the column causing curvature away from the side the hemivertebrae is on. 

- dorsal hemivertebra: leads to kyphosis

- lateral hemivertebrae: leads to scoliosis

- venteral hemivertebrae: leads to lordosis. (rare)

2. Block Vertebrae: failure of separation of two or more adjacent vertebral bodies. "Waspwaist sign"

3. Fused Vertebrae:

4. Unfused vertebrae:

5. Butterfly Vertebra


Neural arch Variants:

1. Arcuate Foramen: calcification of the posterior atlanto-occipital membrane.

2. Congenitatal anomalies of the posterior atlas arch

3. Transitional vertebrae 

- Cervical rib

- Lumbar rib

- Lumbarisation of S1

- Sacralisation of L5


Spinous Process:

1. Unfused spinous process

2. Deviated spinous Process

3. Bifid Spinous Process 


Accessory Ossicles

1. Accessory ossicle of the anterior arch of the atlas

2. Oppenheimers ossicle 


3. Os Odontoideum

4. Persistent ossicculum terminale

5. Sesamoid ossicles of the nuchal ligament. 





  • http://www.svuhradiology.ie/case-study/butterfly-vertebra/

  • https://radiopaedia.org/articles/vertebral-anomalies

  • https://en.wikipedia.org/wiki/Cervical_rib 

  • https://www.ajronline.org/doi/pdf/10.2214/AJR.10.5811

  • https://radiopaedia.org/articles/block-vertebra

  • A sesamoid ossicle of the nuchal ligament mimicking spinous avulsion fractureYuce, Ihsan et al The Spine Journal , Volume 16 , Issue 2 , e39https://www.thespinejournalonline.com/article/S1529-9430(15)01396-0/fulltext

  • Park, Yung & Bok Kim, Hyoung & Woo Jeon, Sang & Tae Lee, Yun & Hyung Yoo, Ju & Chul Oh, Hyun & Ha, Joong-Won & Yong Sung, Seung & Kook Yoon, Han. (2012). The Inferior Accessory Ossicle of the Anterior Arch of the Atlas Misdiagnosed as Anterior Arch Fracture - A Case Report -. Journal of Korean Society of Spine Surgery. 19. 16. 10.4184/jkss.2012.19.1.16. 




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