Complex Spinal Fusion Anomalies (unknown syndromic)

Findings:

Sagittal and coronal multiplanar reconstructions from CT spine demonstrate complex fusion anomalies at every level, to the extent that individual spine numbering is virtually impossible. Note that the entirety of the thoracic and lumbar spine is included on the sagittal reconstruction and demonstrates that there are no more than 9 discrete identifiable combined thoracic and lumbar segments, with 17 expected. Coronal reconstructions also reveal the presence of multiple butterfly and/or hemivertebrae which further complicate numbering. Additional costovertebral fusion anomalies are present.

Differential Diagnosis/Discussion:

The differential diagnosis of spinal fusion anomalies includes congenital such as Klippel Feil syndrome which more commonly is isolated to the cervical spine near C2. Juvenile chronic arthritis can cause multiple disc space and/or facet fusion. Fused/ankylosed disc spaces may also be seen with previous infection or postoperative change. The presence of multiple superimposed vertebral anomalies indicates that this is a congenital and not an acquired process.