Interpedicular graft using a titanium mesh cage in a patient with lumbar scoliosis associated with a congenital butterfly vertebra

Abstract

A butterfly vertebra is a congenital anomaly often associated with a series of syndromic diseases and is often recognized incidentally without any presenting symptoms. The authors report the case of a 13-year-old girl with lumbar scoliosis and mild spondylolisthesis associated with a butterfly vertebra at L-6 causing radiculopathy. The L-5 and L-6 nerve roots were entrapped at the intervertebral foramina between L-5 and the butterfly vertebra (L-6) and between L-6 and S-1 in the concave side. To decompress and preserve the two nerve roots, correct the deformity, and obtain a solid bone fusion, surgery involving the thorough removal of the facet joints between L-5 and L-6 and between L-6 and S-1 in the concave side was performed, with a partial resection of the butterfly vertebra and the placement of a titanium mesh cage between the L-5 and S-1 pedicles dorsal to the nerve roots. Complete pain relief and correction of the deformity with solid bone fusion was obtained after a 2-year follow-up period.

Butterfly vertebra. A case report and a short review of the literature

“…Boulet et al [1] described a novel case of S1 sagittal cleft vertebra, accompanied by space narrowing at L5-S1 level. Butterfly formation of vertebra can be part of syndromic diseases such as Pfeiffer, Jarcho-Levin, Crouzon or Alagille [1,16] or associated by additional spinal anomalies such as intervertebral bars, supernumerary lumbar vertebrae, spina bifida, diastematomyelia, kyphosis/scoliosis or kyphoscoliosis [5].…”

“…Clinical manifestations usually include chronic, periodic low back pain, usually of many years duration before diagnosis, without neurological deficits [1,4,5,16,18]. It was considered to be of low clinical importance.…”

“…Herniated disc may be located at inferior [16], superior [1] or correspondent level protruding throughout the sagittal cleft [4]. Cui et al [5] described a novel case of L6 butterfly vertebra associated with scoliosis and spondylolisthesis at L5-L6 and L6-S1 levels, where altered lumbosacral anatomy due to butterfly vertebra caused entrapment of L5, L6 roots and neurologic deficit [5]. Moreover, alteration in vascular supply to the anterior area of vertebral body is a potential aetiologic factor for anterior hypoplasia.…”

Butterfly Vertebra and other Congenital Vertebral Anomalies in a Child

“…10 Amalgamation of spinal anomalies like spina bifida, supernumerary lumbar vertebrae, intervertebral bars, kyphosis/ scoliosis or kyphoscoliosis, diastematomyelia may also be found with butterfly vertebra. 11 This case is unique in the sense that it is very rare; the fourth reported case in thoracic vertebra after 1990 and diagnosed at the early age of 2 years. While previous case reports from 1990 to 2015, the cases were involved patients who were more than 10 years of age.…”

“…13 The clinical features of butterfly vertebra may be periodic, with a low back pain of long duration without any neurological deficits and of low clinical importance 7 Cui 11 reported L6 butterfly vertebra which was associated with neurologic deficit. 11 The mode of treatment is conservative while surgery is preffered in cases presenting with low back pain, sciatica and/ or motor deficiency including laminectomy (for root decompression) with or without spinal fusion and instrumentation. 14…”