Disclosures: Chris Andriano, DO: No financial relationships or conflicts of interest

Case Diagnosis: Acute on chronic back pain with radiculopathy in patient with congenital butterfly vertebra.

Case Description: Fifty-nine-year-old male with chronic left low back pain for 6 years presents to clinic due to progressively worsening symptoms over last year. Associated with radicular symptoms described as shooting and tingling, into left buttock and posterior leg primarily. Exacerbated with prolonged standing and walking. Denied numbness, weakness, bowel or bladder dysfunction, constitutional, cardiac, endocrine or craniofacial symptoms. Patient had been very active – performing stretches, core strengthening exercises, spinning, and golf. Exam was pertinent for loss of lumbar lordosis, and 4+ of 5 weakness to left hip flexion. Due to weakness on exam, MRI of lumbar spine was obtained. MRI revealed congenital type fusion anomalies involving T10 through L5, most severe at T10 and T12 demonstrating butterfly-type vertebrae; and severe foraminal stenosis on the left at L3-4. Patient did not want to pursue formal physical therapy and was therefore referred for transforaminal epidural injection on the left at L2-3 and L3-4, which was reported to be technically difficult as per an experienced interventional spine physician. Patient reported great pain relief from this procedure.

Setting: Outpatient private practice.Assessment/

Results: This patient had symptoms related to transforaminal stenosis at L3-4 with correlative examination findings and improvement of symptoms after epidural.

Discussion: A butterfly vertebra is a rare congenital anomaly caused by failure of fusion of the 2 lateral chondrification centers during embryogenesis leading to sagittal defect of vertebral body. It is associated with spinal deformity and multiple butterfly vertebrae may indicate syndromic illness, which requires further exploration upon identification. The etiology of low back pain in a patient with butterfly vertebra is not well established.

Conclusion: This case demonstrates an incidental finding of butterfly vertebra. Clinicians should be aware of this condition and associated syndromes.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/butterfly-vertebral-defect-a-rare-anomaly-of-the-spine-a-case-report/