E1803. Congenital Vertebral Anomalies: A Practical Approach
  1. Nassier Harfouch ; Staten Island University Hospital
  2. Jihyun Kang ; Staten Island University Hospital
  3. Mark Raden ; Staten Island University Hospital
  4. Ami Gokli ; Staten Island University Hospital
Congenital vertebral body (CVB) anomalies are commonly encountered in pediatric imaging and have a wide spectrum of presentations. The array of subtle findings makes their diagnosis and subsequent categorization difficult. It is important to properly describe the appropriate positive as well as pertinent negative findings when reporting on CVB anomalies, as incorrect classification may translate into inappropriate follow-up imaging and patient management. This exhibit will succinctly review the pathophysiology of CVB anomalies and then provide a practical and structured approach for the radiologist to properly describe relevant findings in the report.

Educational Goals / Teaching Points
Review the current understanding of basic spinal embryology and how errors in development occur. Describe associated congenital anomalies with regards to frequency, clinical presentation and pathophysiology. Present a structured approach to identify and categorize vertebral body anomalies through multi-modality case-based examples.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Accurate radiologic interpretation of structural developmental anomalies of the vertebral column requires a thorough understanding of spinal embryology, common patterns of developmental errors, and clinical implications. Vertebral malformations can arise due to errors in formation, segmentation, or a combination of both. We review the essentials of embryology with an emphasis on when and how specific developmental anomalies occur. We review normal vertebral body anatomy, variant anatomy and illustrative, multi-modality case examples of vertebral malformations including butterfly vertebrae, hemivertebra, unilateral segmented bar with contralateral hemivertebrae, double convex hemivertebrae, single free convex hemivertebrae, block vertebrae, etc. We discuss associated syndromic and non-syndromic conditions through case examples including VACTERL, Klippel Feil, Sprengel Deformity, and other common associated genitourinary, cardiac and spinal cord malformations. We present a structured approach to vertebral anomaly image interpretation.

A practical and structured approach in evaluating, categorizing, and reporting congenital vertebral body anomalies is provided. After completing this educational exhibit, the radiologist will possess a basic understanding of the embryonic development of the spine. Additionally, the radiologist will be able to report on the typical radiological imaging findings of common vertebral body anomalies in a structured manner. An accurate report with pertinent positives and negatives can better direct appropriate medical and surgical management.