MDCT of Variations and Anomalies of the Neural Arch

and Its Processes: Part 1—Pedicles, Pars

Interarticularis, Laminae, and Spinous Process
José M. Mellado1, Raquel Larrosa1 2, Joaquín Martín1, Nerea Yanguas1

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Symmetric pedicle thinning is frequently observed at the thoracolumbar junction [4]. This feature may falsely suggest
a space-occupying lesion on conventional radiographs. However, it is a common normal variant at the L1 and L2
levels that can be easily identified on MDCT studies (Figs. 1A, 1B, and 1C).

Target pedicles of T12 are occasionally found on radiographic examinations of the dorsal spine [5]. It has been
shown that superimposition of the tubercles of the T12 transverse processes contributes to the ring shadow within the
pedicle, which is optimally shown on MDCT images (Figs. 2A, 2B, and 2C).

The neurocentral synchondrosis is the cartilaginous growth plate between the body and arch of a vertebra. The
neurocentral synchondrosis can hardly be seen on MDCT (Figs. 3A, 3B, 3C, and 3D) or MRI of pediatric patients.
Persistence of neurocentral synchondrosis in a skeletally mature individual may rarely occur [6], occasionally in
association with a hypoplastic spinous process.

Retrosomatic clefts, also termed “pediculolysis,” are linear, usually vertical defects at the vertebral pedicle. Involved
pedicles may be elongated, shortened, or thickened. These clefts commonly derive from a prior fracture, although
coexistent anomalies may suggest a congenital cause [7]. Although unilateral retrosomatic clefts usually lack clinical
significance, bilateral defects may cause spinal instability.

The congenital absence and hypoplasia of vertebral pedicles involve, in decreasing order of frequency, the lumbar,
cervical, and dorsal spine. Radiographic characterization of these two pedicle deficiencies may be difficult given their
overlapping manifestations. Investigators have suggested that many of the previously reported cases of an absent
pedicle may, in retrospect, represent hypoplasia [8].

On conventional radiographs, the congenital absence of a cervical pedicle typically presents with a falsely enlarged
neural foramen; a dysplastic, dorsally displaced ipsilateral articular pillar and lamina; and a dysplastic ipsilateral
transverse process. Some of these features may be subtle or misleading on conventional projections and are better
seen on oblique views. Axial MDCT images may help confirm the diagnosis and may show additional features, such
as incomplete transverse foramen and anterior displacement of the transverse process. Parasagittal reformations and
volume-rendered MDCT images are optimal for the depiction of the abnormal joint between the dorsally displaced
articular pillar and the supraadjacent one. This feature, which may be described as the “pseudo-locked facet” sign,
should not be mistaken for a true facet dislocation [9]. Identification of a normal “hamburger bun” sign on axial MDCT
images will help rule out facet dislocation [10] (Figs. 4A, 4B, 4C, 4D, and 4E).

On conventional radiographs, the congenital absence of a thoracolumbar pedicle may be subtle or misleading,
although associated features such as abnormal enlargement of the intervertebral foramen may help detect the
anomaly [8]. On axial MDCT images, the congenital absence of a thoracolumbar pedicle is typically associated with a
small anteriorly displaced transverse process [11]. The anterior attachment of the transverse process can be
interpreted as a hypoplastic pedicle, which may also occur. Additional features include dysplasia of the ipsilateral
superior articular facet, tilt of the spinous process, contralateral arch hypertrophy and sclerosis, and rib abnormalities.
A vertical cleft through the superior facet may be found [12]. On oblique sagittal MDCT reformations, this latter finding
manifests as the previously undescribed “dog muzzle” sign (Figs. 5A, 5B, 5C, 5D, and 5E). When an absent pedicle
coexists with segmentation anomalies, parasagittal and oblique sagittal MDCT reformations help detect abnormal
fusion of laminae and joint facets (Figs. 6A, 6B, and 6C).
Block vertebrae typically show dysplastic nonfused pedicles. Interpedicular fusion may be found in congenital
scoliosis. Idiopathic unilateral hypertrophy of multiple pedicles has also been described [13].

THE PARS INTERARTHRICULARIS

The pars interarticularis or isthmus is located between the inferior and superior articular processes of the facet joint,
anterior to the lamina and posterior to the pedicle.

At the cervical spine, the articular pillar is the equivalent of the pars interarticularis. A cleft through the articular pillar
of the cervical vertebra is called “cervical spondylolysis,” which is typically bilateral, probably congenital, and
occasionally symptomatic.

A cleft through the pars interarticularis of a lumbar vertebra is termed “isthmic spondylolysis.” Isthmic spondylolysis
may be congenital, although most defects of the pars interarticularis derive from an acute or stress fracture. In fact,
isthmic spondylolysis may be found in both dysplastic (developmental) and isthmic (acquired) spondylolisthesis,
corresponding to types I and II of the classification described by Wiltse et al. [14].

Dysplastic spondylolisthesis predominates at the L5–S1 level and is caused by congenital insufficiency of the facet
joints and disk complex. It may be classified as low or high dysplastic. High dysplastic spondylolisthesis tends to
present with small and dysplastic articular processes, usually sagittally oriented and prone to anterior subluxation.
The pars interarticularis is attenuated or elongated but may also undergo spondylolysis (Figs. 7A, 7B, 7C, and 7D).
Additional findings include spina bifida occulta, posterior wedging of the L5 vertebral body, convexity at the superior
sacral dome, and increased lumbosacral angle [14].

Isthmic spondylolisthesis implies a defect of the pars interarticularis. Isthmic spondylolysis may be identified on lateral
radiographs but is better seen on oblique views, appearing on imaging as the so-called “scotty dog” sign. Isthmic
spondylolysis is also readily seen on parasagittal reformatted MDCT images, although the classic radiographic sign at
the L5 vertebra may be hard to reproduce on oblique sagittal volume-rendered MDCT reformations (Figs. 8A, 8B,
and 8C).

Unilateral isthmic spondylolysis is probably an acquired lesion and usually remains asymptomatic. It may be
associated with sclerosis and hypertrophy of the contralateral neural arch and may precipitate contralateral isthmic
spondylolysis. It also may cause stress fracture of the contralateral pedicle [15] (Figs. 9A, 9B, and 9C) or may be
associated with spina bifida occulta (F34Fig. 10).

The Laminae
The retroisthmic cleft, one of the rarest forms of neural arch anomaly, involves the lamina immediately dorsal to the
inferior articular process. Although a traumatic cause has been suggested [16], retroisthmic cleft may be associated
with other congenital anomalies such as ipsilateral deviation of the spinous process, ipsilateral facet dysplasia, and
contralateral pedicle hypoplasia (Figs. 11A, 11B, 11C, and 11D).

Other anomalies of the laminae may be found such as agenesis, which is associated with segmental anomalies;
hypoplasia; or fusion.

The Spinous Process

Spinal dysraphism implies a failure of fusion of the neural arch and typically is associated with CNS abnormalities.
Spina bifida occulta, the closed and mild form of spinal dysraphism, usually involves the transitional levels of the
spine, most commonly the L5 and S1 segments, and is generally regarded as an incidental finding. The term “spina
bifida occulta” is used to describe midline defects of the neural arch, such as an unfused spinous process
(Figs. 12A and 12B), laminae, or both (Figs. 13A, 13B, 13C, and 13D). The spinous process may remain unattached,
held by the ligamentum flavum, or may fuse with the contiguous spinous process to cause the so-called “clasp-knife”
deformity. The midline defect may also extend into the sacral canal (F45Fig. 14). Spina bifida occulta may be
associated with skin abnormalities or a tethered cord [17, 18].
Spinous process deviation may reflect rotation of the entire vertebra or developmental asymmetry of the neural arch
[19]. This latter variant may cause confusion in the interpretation of anteroposterior radiographs of the spine and may
simulate vertebral body malalignment. In this setting, MDCT may be used to establish the correct diagnosis
(Figs. 15A and 15B).

Hypoplasia of the spinous process may occur (Figs. 12A and 12B). Persistent ossification centers of the spinous
process may also be found (Fig. 16). These centers have smooth round borders, resembling typical accessory
ossicles, that should not be confused with fracture.

Read More: https://www.ajronline.org/doi/10.2214/AJR.10.5803