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Approach to Spine and Spinal Cord Development
Kevin R. Moore, MD
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Terminology

  • Definitions

    • Morphogenetic fields
      • Embryologic cellular regions with potential for development into discrete anatomic structures
    • Gradient fields
      • Describe gradually varying potential to form specific individual bones and organs within morphogenetic field
    • Homeobox genes
      • Gene family complexes that regulate early embryologic differentiation
      • Located on separate chromosomes
      • Arranged linearly in same order as expression along craniocaudal axis

Imaging Protocols

  • Multiplanar magnetic resonance imaging best evaluates soft tissues, neural structures, and ligaments. Multidetector axial CT with sagittal and coronal reconstruction optimally defines bone anatomy.

Embryology

  • The spinal axis develops following a (mostly) orderly progression of steps, with the vertebral axis and spinal cord developing synchronously. Embryologic spine formation begins in the occipital region, then subsequently commences at multiple other sites simultaneously. These sites progress at different rates and thus will be at different developmental stages at any given point in time. The cephalic spine (to about the conus level) forms by the process of primary neurulation, while the caudal spine forms separately by secondary neurulation (also called canalization and retrogressive differentiation). Most spinal anomalies may be explained by 1 or more events going awry during these steps.
  • Primary Neurulation

    • Premature Dysjunction

      • Nondysjunction

        • Secondary Neurulation (Formerly Canalization and Retrogressive Differentiation)

          • Vertebral Formation and Segmentation

            • Spinal Cord

              • Notochordal Anomalies

                • Congenital and Developmental Anomalies of Unknown Etiology

                  Selected References

                  1. Kim JW et al: Limited dorsal myeloschisis: reconsideration of its embryological origin. Neurosurgery. 86(1):93-100, 2020
                  2. Rhodes RH: Congenital spinal lipomatous malformations. Part 1. Spinal lipomas, lipomyeloceles, and lipomyelomeningoceles. Fetal Pediatr Pathol. 1-52, 2019
                  3. Rhodes RH: Congenital spinal lipomatous malformations. Part 2. Differentiation from selected closed spinal malformations. Fetal Pediatr Pathol. 1-37, 2019
                  4. Ausili E et al: Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging. Childs Nerv Syst. 34(2):285-91, 2018
                  5. Chaturvedi A et al: Malformed vertebrae: a clinical and imaging review. Insights Imaging. 9(3):343-55, 2018
                  6. Shoja MM et al: Embryology of the craniocervical junction and posterior cranial fossa, part I: development of the upper vertebrae and skull. Clin Anat. 31(4):466-87, 2018
                  7. Ward L et al: The role of the notochord in amniote vertebral column segmentation. Dev Biol. 439(1):3-18, 2018
                  8. Lee SM et al: Limited dorsal myeloschisis and congenital dermal sinus: comparison of clinical and MR imaging features. AJNR Am J Neuroradiol. 38(1):176-82, 2017
                  9. Scaal M: Early development of the vertebral column. Semin Cell Dev Biol. 49:83-91, 2016
                  10. Babu R et al: Concurrent split cord malformation and teratoma: dysembryology, presentation, and treatment. J Clin Neurosci. 21(2):212-6, 2014
                  11. Gupta P et al: Congenital spinal cord anomalies: a pictorial review. Curr Probl Diagn Radiol. 42(2):57-66, 2013
                  12. Rufener S et al: Imaging of congenital spine and spinal cord malformations. Neuroimaging Clin N Am. 21(3):659-76, viii, 2011
                  13. Rossi A et al: Current classification and imaging of congenital spinal abnormalities. Semin Roentgenol. 41(4):250-73, 2006
                  14. Tortori-Donati P et al: Magnetic resonance imaging of spinal dysraphism. Top Magn Reson Imaging. 12(6):375-409, 2001
                  15. Tortori-Donati P et al: Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology. 42(7):471-91, 2000
                  16. Pang D: Sacral agenesis and caudal spinal cord malformations. Neurosurgery. 32(5):755-78; discussion 778-9, 1993
                  17. Pang D et al: Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations. Neurosurgery. 31(3):451-80, 1992
                  Related Anatomy
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                  Related Differential Diagnoses
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                  References
                  Tables

                  Tables

                  Terminology

                  • Definitions

                    • Morphogenetic fields
                      • Embryologic cellular regions with potential for development into discrete anatomic structures
                    • Gradient fields
                      • Describe gradually varying potential to form specific individual bones and organs within morphogenetic field
                    • Homeobox genes
                      • Gene family complexes that regulate early embryologic differentiation
                      • Located on separate chromosomes
                      • Arranged linearly in same order as expression along craniocaudal axis

                  Imaging Protocols

                  • Multiplanar magnetic resonance imaging best evaluates soft tissues, neural structures, and ligaments. Multidetector axial CT with sagittal and coronal reconstruction optimally defines bone anatomy.

                  Embryology

                  • The spinal axis develops following a (mostly) orderly progression of steps, with the vertebral axis and spinal cord developing synchronously. Embryologic spine formation begins in the occipital region, then subsequently commences at multiple other sites simultaneously. These sites progress at different rates and thus will be at different developmental stages at any given point in time. The cephalic spine (to about the conus level) forms by the process of primary neurulation, while the caudal spine forms separately by secondary neurulation (also called canalization and retrogressive differentiation). Most spinal anomalies may be explained by 1 or more events going awry during these steps.
                  • Primary Neurulation

                    • Premature Dysjunction

                      • Nondysjunction

                        • Secondary Neurulation (Formerly Canalization and Retrogressive Differentiation)

                          • Vertebral Formation and Segmentation

                            • Spinal Cord

                              • Notochordal Anomalies

                                • Congenital and Developmental Anomalies of Unknown Etiology

                                  Selected References

                                  1. Kim JW et al: Limited dorsal myeloschisis: reconsideration of its embryological origin. Neurosurgery. 86(1):93-100, 2020
                                  2. Rhodes RH: Congenital spinal lipomatous malformations. Part 1. Spinal lipomas, lipomyeloceles, and lipomyelomeningoceles. Fetal Pediatr Pathol. 1-52, 2019
                                  3. Rhodes RH: Congenital spinal lipomatous malformations. Part 2. Differentiation from selected closed spinal malformations. Fetal Pediatr Pathol. 1-37, 2019
                                  4. Ausili E et al: Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging. Childs Nerv Syst. 34(2):285-91, 2018
                                  5. Chaturvedi A et al: Malformed vertebrae: a clinical and imaging review. Insights Imaging. 9(3):343-55, 2018
                                  6. Shoja MM et al: Embryology of the craniocervical junction and posterior cranial fossa, part I: development of the upper vertebrae and skull. Clin Anat. 31(4):466-87, 2018
                                  7. Ward L et al: The role of the notochord in amniote vertebral column segmentation. Dev Biol. 439(1):3-18, 2018
                                  8. Lee SM et al: Limited dorsal myeloschisis and congenital dermal sinus: comparison of clinical and MR imaging features. AJNR Am J Neuroradiol. 38(1):176-82, 2017
                                  9. Scaal M: Early development of the vertebral column. Semin Cell Dev Biol. 49:83-91, 2016
                                  10. Babu R et al: Concurrent split cord malformation and teratoma: dysembryology, presentation, and treatment. J Clin Neurosci. 21(2):212-6, 2014
                                  11. Gupta P et al: Congenital spinal cord anomalies: a pictorial review. Curr Probl Diagn Radiol. 42(2):57-66, 2013
                                  12. Rufener S et al: Imaging of congenital spine and spinal cord malformations. Neuroimaging Clin N Am. 21(3):659-76, viii, 2011
                                  13. Rossi A et al: Current classification and imaging of congenital spinal abnormalities. Semin Roentgenol. 41(4):250-73, 2006
                                  14. Tortori-Donati P et al: Magnetic resonance imaging of spinal dysraphism. Top Magn Reson Imaging. 12(6):375-409, 2001
                                  15. Tortori-Donati P et al: Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology. 42(7):471-91, 2000
                                  16. Pang D: Sacral agenesis and caudal spinal cord malformations. Neurosurgery. 32(5):755-78; discussion 778-9, 1993
                                  17. Pang D et al: Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations. Neurosurgery. 31(3):451-80, 1992