. As such, articles are written and edited by countless contributing members over a period of time. (2022), including thick eyebrows with synophrys, broad nasal bridge, and prominent chin. Congenital & Acquired Childhood Platyspondyly. Vertebral Body Sclerosis. Anterior wedging. Articles are a collaborative effort to provide a single canonical page on all topics relevant to the practice of radiology. True ribs connect to the sternum by their own costocartilage. In thanatophoric dwarfism (OMIM 187600) there is severe platy- spondyly with notch-like ossification defects of the middle portion of the vertebral body and a band-like appearance of vertebrae. Pedro Sanchez, John M. Graham Jr., in Swaiman's Pediatric Neurology (Sixth Edition), 2017. She also had mildly elongated femoral necks, and mild platyspondyly with small anterior vertebral body projections. Bullet-shaped or ovoid vertebra refers to the anterior beaking of the vertebral body. A skeletal survey was obtained to assess for other occult injuries. In stages 1 and 2 (vertebral body blunting and beaking), the structural integrity of the anterior column is partially intact, and complete ligamentous failure of the posterior annulus has not occurred. [radiopaedia.org] Skeletal abnormalities include kyphoscoliosis, anterior beaking and wedging . Vertebral body abnormalities in MPS type II. Stage 1 involves rounding over of the superior endplate. The disorder is caused by deficient activity of the lysosomal enzyme glycosylasparaginase, which results in body fluid and tissue accumulation of a series of glycoasparagines, i.e., glycoconjugates with an aspartylglucosamine . Case Discussion There is clearly a systemic process at play here and with the anterior vertebral body beaking, we should be well on our way to a differential diagnosis. Case Discussion. 1). Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Bullet-Shaped Vertebra/Anterior Vertebral Body Beaking Usually described Spinal CT findings: platyspondyly hypoplasia of odontoid peg Hyperflexion: If posterior ligament is intact, wedging of vertebral body occurs.If torn, may cause subluxation. Xrays showed anterior beaking of vertebrae involving T12 to L4, and platyspondyly. . Typical cervical vertebrae, such as C4 or C5, have several characteristic features that differentiate them from thoracic or lumbar vertebrae (Figure 7. Marked vertebral flattening is also a striking feature. Fish (Biconcave) or H-Shaped Vertebra. SEDDON classification: I. NEUROPRAXIA : A sudden, temporary block of nerve conduction without disruption of the mechanical integrity of the nerve.-transient disorder (spontan recovery), several weeks-EMG of the distal lesion usually normal-Caused by mechanical pressure, exp : crutch paralysis tourniquet paralysis-good . spondyly with notch-like ossification defects of the middle portion of the vertebral body and a band-like appearance of vertebrae. Enlarged vertebral body Squaring of one or more vertebral bodies Fused vertebrae Atlanto-axial subluxation Conditions producing disc space narrowing Intervertebral disc calcifications Coronal cleft vertebral bodies Anterior vertebral body beaking Posterior scalloping of the vertebral bodies Anterior scalloping of the sacrum Ivory vertebrae. Without the history of trauma and the followup imaging that demonstrates healing, the second of these studies has an anterior vertebral body beak that would prompt any pre-exam registrar to real off a list of differentials including Morquio syndrome. MRI cervical spine is advised to look for spinal cord intregity and dynamic views for stability. Case Discussion. Plain radiograph / CT Axial manifestations platyspondyly hypoplasia of odontoid peg atlantoaxial subluxation os odontoideum anterior central vertebral body beaking round vertebral [radiopaedia.org] There are multiple abnormalities of the spine ( platyspondyly , odontoid hypoplasia, cervical subluxation and cervical myelopathy). Like the C3 through C6 vertebrae, C7 has a thicker area of bone called the body, located anterior to the vertebral foramen. Anterior vertebral body beaking occurs in a number of conditions and may emanate from the central portion or the lower third of the vertebral body. When findings such as anterior beaking of vertebrae or bilateral femoral head dysplasia are present, MPS IVA should be included in the differential diagnosis. In Hurler syndrome (MPS 1H) beaking often occurs at the inferior aspect of the anterior vertebra, while Morquio syndrome (MPS IV) and pseudoachodroplasia are often associated with beaking of the middle portion of the anterior vertebra [ 20 ]. The other vertebral bodies have a short anteroposterior dimension and are ovoid with concave anterior and posterior margins and convex superior and inferior end plates. Vertebral scalloping | Radiology Reference Article | Radiopaedia.org A global group of dedicated editors oversee accuracy, consulting with expert advisers, and constantly reviewing additions. These findings are consistent with morquios disease with platyspondyly, anterior beaking and kyphotic deformity, along with upper cervical fusion and os odontoideum. There is clearly a systemic process at play here and with the anterior vertebral body beaking, we should be well on our way to a differential diagnosis.Since the beaking is inferior, don't include Morquio syndrome. Anterior beaking is further exacerbated in the thoracic tract by the spinal kyphosis. Vertebral Shape . The middle and posterior columns are spared in these early stages. Marked vertebral flattening is also a striking feature. The first group comprises variants mimicking pathological vertebral height loss, including not-yet-ossified vertebral apophyses superiorly and inferiorly, which can lead to a vertebral shape easily over-interpreted as anterior wedge fracture, physiological beaking, or spondylolisthesis associated with shortened posterior vertebral height. Anterior vertebral body beaking is typical of pseudoachondroplasia and the mucopolysaccharidoses (MPS). Hurler Syndrome (mucopolysaccharidosis type I) usually presents with vertebrae showing anterior inferior beaking, and Morquio syndrome (mucopolysaccharidosis type IV) patients more frequently show anterior central vertebral body beaking and round vertebral bodies (33,34). [radiopaedia.org] Skeletal abnormalities include kyphoscoliosis, anterior beaking and wedging . Pre-operative imaging with CT cervical spine bone window (figure 2) revealed hypoplastic dens, flattened vertebral bodies with central anterior beaking at multiple levels. a Lateral radiograph shows exaggerated anterior wedging (near 25% height loss) in a mid-thoracic vertebra ( asterisk) in a 7-year-old girl treated with glucocorticoids for linear scleroderma. Anterior vertebral body beaking Central Morquio's syndrome (References only) Lower third Hurler's syndrome (References only) Achondroplasia Pseudoachondroplasia (References only) Cretinism (References only) Down's syndrome Neuromuscular diseases (References only) and pear shaped vertebrae. Fish (Biconcave) or H-Shaped Vertebra. According to Allen and Ferguson, there are five stages of flexion-compression injuries ( Fig. Hurler Syndrome (mucopolysaccharidosis type I) usually presents with vertebrae showing anterior inferior beaking, and Morquio syndrome (mucopolysaccharidosis type IV) patients more frequently show anterior central vertebral body beaking and round vertebral bodies (33,34). short and wide tubular bones; metaphyseal flaring in long bones; multiple . Anterior beaking of vertebrae; Anterior beaking of vertebral bodies; Anterior wedging; Beaked vertebral bodies . It is seen in the following conditions: mucopolysaccharidosis (Morquio disease, Hurler disease) achondroplasia congenital hypothyroidism See also weapons. There is hypoplasia of the anterosuperior aspect of the vertebral body at the thoracolumbar junction resulting in an anteroinferior beaking appearance. Anomalies of Foramen Magnum. She exhibited facial dysmorphisms similar to those previously reported in an Indian girl with AMD by Diaz-Gonzalez et al. Anterior beaking is further exacerbated in the thoracic tract by the spinal kyphosis. . Anterior cortical buckling: beaking in dysplasia or neuromuscular disease. Linear Ossification Along Anterior Spine. If premature suture fusion occurs and/or endochondral ossification is abnormal, a small foramen magnum . Background Vertebral Lesions . Stage 2 involves further collapse of the endplate, with beaking, or anterior fracture, of the vertebral body. The foramen magnum is an oval-shaped opening in the occipital bone bound by the basiocciput anteriorly, the occipital condyles laterally, and the supraocciput posteriorly. Lateral radiograph of the thoracic spine shows anterior beaking (white arrow) and posterior scalloping (black arrow). Spinal Osteophytes. A global group of dedicated editors oversee accuracy, consulting with expert advisers, and constantly reviewing additions. Clearly, trauma needs to be on the differential list as well. Kyphotic deformity was seen at D11-D12 level. Accentuation of normal physiological anterior vertebral body beaking at the thoracolumbar junction is seen in conditions affecting epiphyses or epiphyseal equivalents such as the ring apophyses. Anterior vertebral body beaking Central Morquio's syndrome (References only) Lower third Hurler's syndrome (References only) Achondroplasia Pseudoachondroplasia (References only) Cretinism (References only) Down's syndrome Neuromuscular diseases (References only) The disorder is caused by deficient activity of the lysosomal enzyme glycosylasparaginase, which results in body fluid and tissue accumulation of a series of glycoasparagines, i.e., glycoconjugates with an aspartylglucosamine . Anterior wedge compression fractures were noted in the thoracic spine extending from T5-12 (Fig. In both sexes it has been found that diminution of vertebral body size is a more . Vertebral Shape . Squaring of One or More Vertebra. Articles are a collaborative effort to provide a single canonical page on all topics relevant to the practice of radiology. . Case Discussion There is clearly a systemic process at play here and with the anterior vertebral body beaking, we should be well on our way to a differential diagnosis. Vertebral Body Sclerosis. Bullet-Shaped Vertebra/Anterior Vertebral Body Beaking. Linear Ossification Along Anterior Spine. 6.1 ). Vertebral Lesions . Articles. As such, articles are written and edited by countless contributing members over a period of time. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Bullet-Shaped Vertebra/Anterior Vertebral Body Beaking . Calvarial manifestations. Enlarged vertebral body Squaring of one or more vertebral bodies Fused vertebrae Atlanto-axial subluxation Conditions producing disc space narrowing Intervertebral disc calcifications Coronal cleft vertebral bodies Anterior vertebral body beaking Posterior scalloping of the vertebral bodies Anterior scalloping of the sacrum Ivory vertebrae. Anterior beaking of vertebrae; Anterior beaking of vertebral bodies; Anterior wedging; Beaked vertebral bodies . and pear shaped vertebrae. anterior central vertebral body beaking; round vertebral bodies coxa valga; goblet shaped flared iliac wings, increased acetabular angles and constricted iliac bone base; Calvarial manifestations. hypertelorism; dolichocephaly Additionally, there was anterior-inferior beaking of the L2 vertebral body with narrowing of the L1-2 disc space. Anterior vertebral body beaking occurs in a number of conditions and may emanate from the central portion or the lower third of the vertebral body. Hurler Syndrome (mucopolysaccharidosis type I) usually presents with vertebrae showing anterior inferior beaking, and Morquio syndrome (mucopolysaccharidosis type IV) patients more frequently show anterior central vertebral body beaking and round vertebral bodies (33,34). anterior central vertebral body beaking; round vertebral bodies; coxa valga goblet shaped flared iliac wings, increased acetabular angles and constricted iliac bone base; P.S: Ovoid vertebral bodies and anteroinferior beaking seen in Hurler's syndrome and other MPS. Articles. ALGABRA ORTHOPAEDIC - Read online for free. Congenital & Acquired Childhood Platyspondyly. In Hurler syndrome (MPS 1H) beaking often occurs at the inferior aspect of the anterior vertebra, while Morquio syndrome (MPS IV) and pseudoachodroplasia are often associated with beaking of the middle portion of the anterior vertebra [ 20 ]. 1. [slideshare.net] The vertebral bodies were dorsally wedged with tongue-like anterior protrusion evident at the thoracolumbar spine (Figure 2). Squaring of One or More Vertebra. The disease is progressive and often results in death secondary to spinal cord involvement These include neuromuscular disease, skeletal dysplasias such as the mucopolysaccharidoses, and congenital hypothyroidism [ 28 ] and may be associated . Axial compression: Causes burst fractures. Accentuation of normal physiological anterior vertebral body beaking at the thoracolumbar junction is seen in conditions affecting epiphyses or epiphyseal equivalents such as the ring apophyses. In both sexes it has been found that diminution of vertebral body size is a more . Anterior vertebral body beaking is typical of pseudoachondroplasia and the mucopolysaccharidoses (MPS). Middle third Morquio syndrome 1 (middle for Morquio) Lower third Hurler syndrome 2 achondroplasia 3 pseudoachondroplasia 4 cretinism 5 Down syndrome neuromuscular diseases References Bullet-Shaped Vertebra/Anterior Vertebral Body Beaking. Anterior beaking: Achondroplasia, radiation induced, Hurler syndrome, Morquio syndrome Helpful Clues for Common Diagnoses • Achondroplasia Rhizomelic dwarfism Exaggerated lumbar lordosis, posterior vertebral scalloping, narrow foramen magnum, congenital spinal stenosis, decreased interpediculate distance PERIPHERAL NERVE INJURY. In thanatophoric dwarfism (OMIM 187600) there is severe platy-. Newborn screening must be considered for early detection, accurate diagnosis, and initiation of treatment to reduce morbidity. (a) MPS II in a 6-year-old boy. Achondroplasia would be close to the top of the list based on the lateral spine appearances.However, the iliac blades are not squared and there is no narrowing of . The first group comprises variants mimicking pathological vertebral height loss, including not-yet-ossified vertebral apophyses superiorly and inferiorly which can lead to a vertebral shape easily over-interpreted as anterior wedge fracture, physiologic beaking, and spondylolisthesis associated with shortened posterior vertebral height. Middle third Morquio syndrome 1 (middle for Morquio) Lower third Hurler syndrome 2 achondropl. While there is a risk of late kyphotic deformity, most patients can be managed in a rigid cervical orthosis or halo-vest orthosis for 8 to 12 . Wolf-Hirschhorn syndrome is a congenital malformation syndrome characterized by pre- and postnatal growth deficiency, developmental disability of variable degree, characteristic craniofacial features ('Greek warrior helmet' appearance of the nose, high forehead, prominent glabella, hypertelorism, high-arched eyebrows, protruding eyes, epicanthal folds, short philtrum, distinct mouth with . Some common radiological findings of Morquio syndrome include platyspondylyof the cervical and thoracic vertebrae, anterior beaking of the cervical vertebral bodies, thoracolumbar kyphosis, odontoid process hypoplasia, and coxa valgaof the hip joints. hypertelorism; dolichocephaly; Peripheral musculoskeletal manifestations. Xrays showed anterior beaking of vertebrae involving T12 to L4, and platyspondyly. Anterior central beaking of vertebral bodies and enlargement of intervertebral discs were noted at multiple levels. Spinal Osteophytes.
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