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Normal Variant
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Normal anatomic variations that simulate pathologic conditions

            IMAGING

            • Cervical Vertebral Pseudosubluxation

              • Incomplete C1 Ring

                • Cervical Ribs

                  • Transitional Vertebral Anatomy

                    • Focal Fatty Marrow

                      • Ectopic Kidney

                        • Conjoined Nerve Root

                          • Incomplete Posterior Lumbar Elements

                            • High Thecal Sac Termination

                              • Imaging Recommendations

                                DIFFERENTIAL DIAGNOSIS

                                  PATHOLOGY

                                  • General Features

                                    • Gross Pathologic & Surgical Features

                                      • Microscopic Features

                                        CLINICAL ISSUES

                                        • Presentation

                                          • Demographics

                                            • Natural History & Prognosis

                                              • Treatment

                                                DIAGNOSTIC CHECKLIST

                                                • Consider

                                                  Selected References

                                                  1. Caranci F et al: Magnetic resonance imaging correlates of benign and malignant alterations of the spinal bone marrow. Acta Biomed. 89(1-S):18-33, 2018
                                                  2. Laouissat F et al: Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J. 27(8):2002-11, 2018
                                                  3. Woo TD et al: Radiographic morphology of normal ring apophyses in the immature cervical spine. Skeletal Radiol. 47(9):1221-8, 2018
                                                  4. O'Brien WT Sr et al: The dens: normal development, developmental variants and anomalies, and traumatic injuries. J Clin Imaging Sci. 5:38, 2015
                                                  5. Shikhare SN et al: Variants and pitfalls in MR imaging of the spine. Semin Musculoskelet Radiol. 18(1):23-35, 2014
                                                  6. Thawait GK et al: Spine segmentation and enumeration and normal variants. Radiol Clin North Am. 50(4):587-98, 2012
                                                  7. Gaca AM et al: Evaluation of wedging of lower thoracic and upper lumbar vertebral bodies in the pediatric population. AJR Am J Roentgenol. 194(2):516-20, 2010
                                                  8. Hanson EH et al: Sagittal whole-spine magnetic resonance imaging in 750 consecutive outpatients: accurate determination of the number of lumbar vertebral bodies. J Neurosurg Spine. 12(1):47-55, 2010
                                                  9. Lotan R et al: Clinical features of conjoined lumbosacral nerve roots versus lumbar intervertebral disc herniations. Eur Spine J. 19(7):1094-8, 2010
                                                  10. De Martino RR et al: Thoracic outlet syndrome associated with a large cervical rib. Vasc Endovascular Surg. 43(4):393-4, 2009
                                                  11. Kanchan T et al: Lumbosacral transitional vertebra: clinical and forensic implications. Singapore Med J. 50(2):e85-7, 2009
                                                  12. White PW et al: Cervical rib causing arterial thoracic outlet syndrome. J Am Coll Surg. 209(1):148-9, 2009
                                                  13. Song SJ et al: Imaging features suggestive of a conjoined nerve root on routine axial MRI. Skeletal Radiol. 37(2):133-8, 2008
                                                  14. Serhan HA et al: Biomechanics of the posterior lumbar articulating elements. Neurosurg Focus. 22(1):E1, 2007
                                                  15. Soleiman J et al: Magnetic resonance imaging study of the level of termination of the conus medullaris and the thecal sac: influence of age and gender. Spine (Phila Pa 1976). 30(16):1875-80, 2005
                                                  16. Lustrin ES et al: Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23(3):539-60, 2003
                                                  17. Shaw M et al: Pseudosubluxation of C2 on C3 in polytraumatized children--prevalence and significance. Clin Radiol. 54(6):377-80, 1999
                                                  18. Castellvi AE et al: Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976). 9(5):493-5, 1984
                                                  Related Anatomy
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                                                  Related Differential Diagnoses
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                                                  References
                                                  Tables

                                                  Tables

                                                  KEY FACTS

                                                  • Terminology

                                                    • Imaging

                                                      • Top Differential Diagnoses

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Definitions

                                                              • Normal anatomic variations that simulate pathologic conditions

                                                            IMAGING

                                                            • Cervical Vertebral Pseudosubluxation

                                                              • Incomplete C1 Ring

                                                                • Cervical Ribs

                                                                  • Transitional Vertebral Anatomy

                                                                    • Focal Fatty Marrow

                                                                      • Ectopic Kidney

                                                                        • Conjoined Nerve Root

                                                                          • Incomplete Posterior Lumbar Elements

                                                                            • High Thecal Sac Termination

                                                                              • Imaging Recommendations

                                                                                DIFFERENTIAL DIAGNOSIS

                                                                                  PATHOLOGY

                                                                                  • General Features

                                                                                    • Gross Pathologic & Surgical Features

                                                                                      • Microscopic Features

                                                                                        CLINICAL ISSUES

                                                                                        • Presentation

                                                                                          • Demographics

                                                                                            • Natural History & Prognosis

                                                                                              • Treatment

                                                                                                DIAGNOSTIC CHECKLIST

                                                                                                • Consider

                                                                                                  Selected References

                                                                                                  1. Caranci F et al: Magnetic resonance imaging correlates of benign and malignant alterations of the spinal bone marrow. Acta Biomed. 89(1-S):18-33, 2018
                                                                                                  2. Laouissat F et al: Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J. 27(8):2002-11, 2018
                                                                                                  3. Woo TD et al: Radiographic morphology of normal ring apophyses in the immature cervical spine. Skeletal Radiol. 47(9):1221-8, 2018
                                                                                                  4. O'Brien WT Sr et al: The dens: normal development, developmental variants and anomalies, and traumatic injuries. J Clin Imaging Sci. 5:38, 2015
                                                                                                  5. Shikhare SN et al: Variants and pitfalls in MR imaging of the spine. Semin Musculoskelet Radiol. 18(1):23-35, 2014
                                                                                                  6. Thawait GK et al: Spine segmentation and enumeration and normal variants. Radiol Clin North Am. 50(4):587-98, 2012
                                                                                                  7. Gaca AM et al: Evaluation of wedging of lower thoracic and upper lumbar vertebral bodies in the pediatric population. AJR Am J Roentgenol. 194(2):516-20, 2010
                                                                                                  8. Hanson EH et al: Sagittal whole-spine magnetic resonance imaging in 750 consecutive outpatients: accurate determination of the number of lumbar vertebral bodies. J Neurosurg Spine. 12(1):47-55, 2010
                                                                                                  9. Lotan R et al: Clinical features of conjoined lumbosacral nerve roots versus lumbar intervertebral disc herniations. Eur Spine J. 19(7):1094-8, 2010
                                                                                                  10. De Martino RR et al: Thoracic outlet syndrome associated with a large cervical rib. Vasc Endovascular Surg. 43(4):393-4, 2009
                                                                                                  11. Kanchan T et al: Lumbosacral transitional vertebra: clinical and forensic implications. Singapore Med J. 50(2):e85-7, 2009
                                                                                                  12. White PW et al: Cervical rib causing arterial thoracic outlet syndrome. J Am Coll Surg. 209(1):148-9, 2009
                                                                                                  13. Song SJ et al: Imaging features suggestive of a conjoined nerve root on routine axial MRI. Skeletal Radiol. 37(2):133-8, 2008
                                                                                                  14. Serhan HA et al: Biomechanics of the posterior lumbar articulating elements. Neurosurg Focus. 22(1):E1, 2007
                                                                                                  15. Soleiman J et al: Magnetic resonance imaging study of the level of termination of the conus medullaris and the thecal sac: influence of age and gender. Spine (Phila Pa 1976). 30(16):1875-80, 2005
                                                                                                  16. Lustrin ES et al: Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23(3):539-60, 2003
                                                                                                  17. Shaw M et al: Pseudosubluxation of C2 on C3 in polytraumatized children--prevalence and significance. Clin Radiol. 54(6):377-80, 1999
                                                                                                  18. Castellvi AE et al: Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976). 9(5):493-5, 1984