Scalloped Vertebral Bodies
Bernadette L. Koch, MD
DIFFERENTIAL DIAGNOSIS
Common
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Vertebral Segmentation Failure
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Spinal Dysraphism
Less Common
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Achondroplasia
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Mucopolysaccharidoses
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Dural Dysplasia
Rare but Important
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Syringomyelia
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Intraspinal Mass
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
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Vertebral Segmentation Failure
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Single or multiple levels, widened or narrow canal ± dorsal scalloping
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Spinal Dysraphism
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Myelomeningocele: Open neural tube defect, wide osseous dysraphism ± diastematomyelia, syrinx, congenital or developmental kyphoscoliosis
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≈ 100% have Chiari 2 malformation
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Lipomyelocele or lipomyelomeningocele: Skin covered; neural placode/lipoma complex contiguous with SQ fat through osseous dysraphic defect
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Diastematomyelia ± fibrous, osteocartilaginous, or osseous spur, intersegmental vertebral fusion, thick filum, or tethered cord
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Helpful Clues for Less Common Diagnoses
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Achondroplasia
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Flat or bullet-shaped vertebra + short pedicles + posterior scalloping
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Spinal stenosis secondary to degenerative disease + congenital short pedicles
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Lumbar hyperlordosis, thoracolumbar kyphoscoliosis
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± costochondral junction stenosis, rarely C1-2 instability
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Mucopolysaccharidoses
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Inherited lysosomal storage disorders, Hurler syndrome (MPS I-H) most common
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Vertebral beaking, thoracolumbar gibbus ± spinal stenosis, dorsal vertebral scalloping
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Narrow foramen magnum, short posterior C1 arch, odontoid hypoplasia
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Dural Dysplasia
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Patulous sac + dorsal vertebral scalloping
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± neurofibromas or other spinal neoplasms in neurofibromatosis type 1
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± arterial dissection or aneurysm in Marfan and Ehlers-Danlos syndrome
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Osteoporosis in homocystinuria
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Helpful Clues for Rare Diagnoses
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Syringomyelia
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± wide canal, spinal dysraphism, Chiari 1, or neoplasm
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Intraspinal Mass
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Intramedullary or extramedullary mass
enlargement of canal &/or vertebral scalloping
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Image Gallery
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