1. Cases of a rare congenital malformation of the spine from osteoarchaeologhical series (Hungary) 1Erika Molnár, 1Andrea Hegyi, 1Antónia Marcsik, 2Mónika Merczi 1 Department of Anthropology, University of Szeged, Hungary 2 Museum of Balassa Bálint, Esztergom, Hungary
Introduction
The vertebral column is one of the body segments most frequently affected by developmental effects. However ’butterfly’ vertebra is a rare malformation of the spine. It is classified as a congenital developmental anomaly in the early embrionic period, resulting in a sagittally cleft vertebral body. The sagittal cleft centrum usually occurs in the lumbar and thoracic spine, and it is found more often in males than in females (1,2). There have been only a few reports of sagittal cleft vertebrae in prehistoric skeletal material (e.g. 3,4,5).
Material
During a study of some congenital and pathological anomalies in skeletal materials coming from different archaeological periods and different geographical areas of Hungary (Fig. 1) three examples of sagittal cleft vertebra were found. The anthropological and paleopathological analyses of the three cemeteries were conducted previously (6,7,8).
Methods
The paleopathological analysis of the examined skeletal material was carried out by macromorphological methods, which were completed by radiological examination.
The anomaly was identified:
- in an adult male from Szarvas cemetery (7-9th c., AD)
in an adult female from Szeged-Makkoserdő cemetery (8th c., AD)
- in an elderly male from Visegrád-Diósd cemetery (4-5th c., AD)
Case 1
In the Szarvas cemetery the presence of sagittal cleft vertebra was observed in the thoracic spine of an adult male individual (Sza-189). The two halves of the 11th thoracic vertebral body are almost equal in size, but a slight hypoplasia of the right half could be detected (Fig. 2). The separation of vertebral halves is incomplete; a bony bridge connects the two parts of the anteriorly wedged-shaped vertebral body (Fig. 3). The butterfly vertebra resulted in kyphosis due to the diminished anterior height of the vertebral body, presumably causing back pain after carrying or heavy lifting for the affected individual during his life.
Fig. 1: Geographic location of the examined skeletal samples
Case 2
The lumbar spine of an adult male (Szeged-Makkoserdő 216) displays sagittal cleft vertebra. It appears in the fourth lumbar vertebra, which body is completely divided into two parts. The two halves are asymmetrically divided by a wide cleft. Hypoplasia of the right parts of the vertebral body can be detected (Fig. 4). All of the other vertebrae are normal except for the adjacent third and fifth lumbar vertebral segments. The third lumbar vertebral body has compensated with increased anterior height, and the fifth vertebral body has raised its superior surface and brodeaned its anterior width as well as its height (Fig. 5, 6). The compensatory changes in the adjacent vertebral segments results in scoliosis.
Fig. 2: Sagittal cleft vertebra – superior view
(Grave No. 189, Adultus, male,
11th lumbar vertebra)
Fig. 3: Sagittal cleft vertebra – anterior view (Grave No. 189, Adultus, male, 11th lumbar vertebra)
Fig. 4: Sagittal cleft vertebra – posterior view (Grave No. 216, Adultus, male, 4th lumbar vertebra)
Case 3
The paleopathological examination of an mature male (Visegrád-Diós cemetery, Grave No. 90) reveals severe developmental defect on the sacrum. The butterfly malformation occurs in the first sacral segment. The vertebral body is separated by narrow cleft and the two halves are almost equal in size (Fig. 7, 8). Compensatory overgrowth of the 5th lumbar vertebra can also be noted. However secondary changes on the anterior surface of the sacrum are worth to mention.
Fig. 5: 3th, 4th and 5th lumbar vertebrae showing compensation (arrows) of L3 and L5 for defect in L4 – anterior view
(Grave No. 216, Adultus, male)
Fig. 6: 3th, 4th and 5th lumbar vertebrae showing compensation (arrows) of L3 and L5 for defect in L4 – laterial view
(Grave No. 216, Adultus, male)
Fig. 7: Sagittal cleft vertebra – superior view
(Grave No. 90, Maturus, male,
1th sacral vertebra)
Fig. 8: Sagittal cleft vertebra – posterior view
(Grave No. 90, Maturus, male,
1th sacral vertebra)
References
1. Barnes, E Developmental Defects of the Axial Skeleton in Paleopathology. Colorado, University Press of Colorado.
2. Aufderheide, A.C., Rodríguez-Martin, C The Cambridge Encyclopedia of Human Paleopathology. Cambridge University Press, Cambridge.
3. Éry, K Balkáni eredetű, török kori népesség csontmaradványai Dombóvár határából. Béri Balogh Ádám Múzeum Évkönyve X-XI:
4. Brasili, P., Bonfiglioli, B., Ventrella, A. R A case of ’butterfly’ vertebra from Sardinia. International Journal of Osteoarchaeology 12:
5. Merbs, Ch.F Sagittal clefting of the body and other vertebral developmental errors in Canadian Inuit skeletons. American Journal of Physical Anthropology 123 No.3:
6. Molnár, E., Marcsik, A Paleopathological evaluation of Hungarian skeletal remains from the 7th-9th centuries AD. Anthropologia Portuguesa 19:
7. Vámos, K „Szeged-Makkoserdő” avar kori népességének embertani vizsgálata. Anthropológiai közlemények 17:
8. Merczi, M Patológiás jelenségek vizsgálata Visegrád-Diós későrómai temetőjében. Wosinszky Mór Múzeum Évkönyve XXIII:
Summary
Similarly to literature data, only one vertebra is involved in our cases and compensatory overgrowth of the adjacent vertebrae can be seen in all cases. The anomaly occurs in the thoracic and lumbar spine and affects only males. In two of the three cases severe form of sagittal clefting are seen: the defect completely separates the vertebral body into right and left sites resulted in full butterfly vertebra.
Because of only few cases have been reported about sagittal cleft vertebrae in the paleopathological literature this report may contributed to our knowledge of this very rare vertebral congenital malformation.
Acknowledgements
This research is supported by the Széchenyi Project (No. 5/081) and the National Scientific Research Foundation (OTKA grant No. D 38476).