Butterfly vertebra: an uncommon congenital spinal anomaly

This is a report of a patient with T6 butterfly vertebra, which is an uncommon congenital spinal anomaly.

To illustrate the significance of identifying butterfly vertebra that may be confused with other pathologic conditions like fractures, infections, and metastases.

We report a 46-year-old woman with butterfly vertebra of T6 spine. The patient presented with complaints of low back pain and examination showed an abnormal bony prominence at midthoracic level. Radiologic and hematologic investigations confirmed the presence of butterfly vertebrae at T6 level, which proved to be a coincidental finding along with nonspecific low back pain. Knowledge about this condition is very important, since the condition can be easily confused with a pathologic fracture.

The patient presented with a history of low back pain of 2 months. The patient was evaluated clinically and with hematological investigations. The diagnosis was confirmed with computerized tomography (CT) and magnetic resonance imaging (MRI) scans.

Routine examination of the motor and sensory system was found to be normal. Roentgenogram of the thoracic and lumbosacral spine showed anterior wedging of T6 vertebrae in the lateral view and features suggestive of the presence of a butterfly vertebra at T6 level in the anteroposterior (AP) view. Hematologic evaluation was done to rule out pathologic causes of anterior wedging of the vertebra like infections and metastases in the spine. MRI and CT scans of the spine confirmed the presence of T6 butterfly vertebra. Patient was treated for her low back pain and assured that the abnormal midthoracic bony prominence was a benign condition that needs no treatment.

A high index of suspicion is needed to identify this benign spinal anomaly that may be confused with many pathologic conditions. Knowledge of this condition helps in making rational use of extensive noninvasive and invasive diagnostic procedures.