agnosis_Spliced Vertebra Plana.gif

AAOS Now

Published 9/1/2011

What’s your Diagnosis?

In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted. The images for this month’s challenge were submitted by John M. Purvis, MD, who provided the following information:

The patient is a 14-year-old healthy girl who was seen for mild idiopathic scoliosis. A standing lateral radiograph was taken and revealed an abnormality of the T-12 vertebra (Fig. A). The patient, however, had no symptoms of back pain, fever, or systemic illness. What is the cause of this “vertebra plana?”

Do you have a challenging case you’d like to submit for publication? Email a short case description and any accompanying images to aaoscomm@aaos.org

Find the answer to this month’s challenge below.

agnosis_Spliced Vertebra PlanaC.gif
(A) Initial standing lateral spliced radiograph suggests an abnormality of the T-12 vertebra. Lateral lumbar (B) and thoracic (C) radiographs appear normal.

Open larger version of images (PDF)

Answer
According to John M. Purvis, MD, who submitted the case, “Most of us have been impressed with the power and flexibility of digital imaging but artifacts in digital radiography can be pretty tricky. Many digital imaging systems need to ‘splice’ images together to get a long image, such as those used for spinal deformity or lower limb alignment. Unfortunately, there can be operator errors, and/or software errors in splicing the images together.

“In this situation,” Dr. Purvis continued, “a splicing error in processing the image gives the appearance of a vertebra plana at T-12 (A). The unspliced thoracic image (C) and the unspliced lumbar image (B) both clearly show that T-12 is normal in shape.”

Do you have a challenging case you’d like to submit for publication? Email a short case description and any accompanying images to aaoscomm@aaos.org