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