The Ivory Vertebra Sign

THE IVORY VERTEBRA SIGN

Sudeep Bajracharya

55 yr old female with lower limb weakness Chest x-ray done with the consideration of

Pott’s spine

Case

Dense T5 vertebraNormal Adjacent IVDsNormal paravertebral space

Chest – Normal findings

MRI - Low signal on both T1W and T2W images

Seen in conventional vertebra Increase in opacity of a vertebral body that

retains its size and contours, No change in the opacity and size of

adjacent intervertebral disks Can involve 1 or more vertebras Seen in both adults and children

What is Ivory Vertebra Sign

Osteoblastic metastasis Paget’s disease Hodgkin’s Lymphoma Idiopathic segmental sclerosis Myelosclerosis Fluorosis Osteopetrosis Osteomyelitis

Causes

Sarcoidosis Chordroma Myeloma Ewing’s Sarcoma Osteoid osteoma Osteoblastoma Bone island

Uncommon causes

Sclerosis of the vertebra is rare in children Causes includes

Hodgkin’s Lymphoma Metastatic neuroblastoma Meduloblastoma Few cases of osteogenic sarcoma and Ewing’s

sarcoma

Causes in children

Breast Prostate Osteosarcoma Lung CA Carcinoid tumors Thyroid

stimulate osteoblasts replacement of vertebral body spongiosa with dense and amorphous bony mass

Metastasis from spine usually involves several vertebra

Osteoblastic metastasis

May mimic ivory vertebra Ewing’s sarcoma Osteosarcoma

Primary bone tumors

Characterised by “picture frame” vertebral body

A.k.a “double contour” or “windowed” Overall uniform opacity with sclerosis most

marked at the periphery Relative central lucency is due to atrophy of

the spongiosa Usually causes expansion of the bone due to

trabecular expansion

Paget’s disease

Hodgkin’s Lymphoma Usually both lytic and sclerotic changes are

seen in the vertebra. Purely osteoblastic changes is quite rare If present, sclerosis can be patchy as well as

generalised Paravertebral soft tissue mass is usually

seen along with the affected vertebra

Lymphoma

A.k.a idiopathic segmental sclerosis May be seen in healing vertebral fractures May mimic ivory vertebra

Reactive bone formation

Ivory vertebra with no apparent cause and remains unchanged after interval studies

Mostly attributed to asymptomatic paget’s disease

Affects 30-50 yrs age group Slightly more predominant in women

Idiopathic Ivory vertebra

Few reports of ivory vertebra caused by sarcoidosis and tuberculosis have been reported

OSTEOMYELITIS – may have ivory vertebra in healing stages Usually involves multiple vertebas with erosive

margins

Inflammatory conditions

Non- specific sign With a diverse disease spectrum accounts

for it In adults, primary consideration for ivory

vertebra should be 1. Osteoblastic metastasis 2. Paget’s disease 3. Lymphoma

Conclusion

Thank you