Disclosures: Lok Valentas, MD: No financial relationships or conflicts of interest

Case Description: A 48 year old female with a history of cholecystectomy presented with a 3 week history of right flank pain, not associated with known injury at onset. Pain was localized to the right flank with radiation to the abdomen and back. Pain was aching in nature, though could be sharp at times. It improved with rest and was exacerbated by sudden movements, twisting, and turning. There was no associated numbness, tingling, weakness, bowel/bladder dysfunction. Prior workup included non-concerning hepatic function panel, urinalysis, lipase, b-hcg, chest x-ray, CTPE, and right upper quadrant abdominal ultrasound. Further investigation revealed a thoracic spine MRI with moderate right neural foraminal narrowing at T8-T9 in the setting of a T9 butterfly vertebra. Given concern for thoracic radiculitis as the driver for the patient’s pain, physical therapy, nortriptyline, and tizanidine were initiated with symptomatic improvement.

Setting: Outpatient Clinic (Comprehensive Spine Center)

Patient: A 48 year old female with right flank pain Assessment/

Results: At 6 month follow up, the patient’s symptoms had improved with conservative care, though she continued to demonstrate moderate right flank pain. Possible epidural steroid injection (L1-2 with catheter to T9/10) was discussed if symptoms are unable to be managed with conservative care.

Discussion: A butterfly vertebra is an uncommon, often benign, congenital failure of vertebral fusion. We discuss here an unusual case of a butterfly vertebra leading to neuroforaminal narrowing and nerve root irritation with thoracic radicular pain.

Conclusion: Though rare and generally an incidental finding, butterfly vertebrae can cause structural pathology that leads to neurologic symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/t9-butterfly-vertebra-causing-neuroforaminal-narrowing-and-nerve-root-irritation-with-thoracic-radicular-pain-a-case-report/