What causes sandwich vertebra in the spine on radiographs?
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Sandwich vertebrae occur due to increased sclerosis (bone density) at the vertebral endplates with a relatively lucent (normal density) central portion of the vertebral body. This radiologic pattern on spine radiographs is classically seen in benign adult autosomal dominant osteopetrosis, a disorder characterized by defective osteoclastic bone resorption leading to abnormally dense, brittle bones. Clinically, patients may present with bone fragility, fractures, and other features of osteopetrosis.
Why is it called so?
The name “sandwich vertebra” reflects the visual appearance on imaging, where the dense sclerotic endplates resemble the “bread slices” of a sandwich, and the less dense central vertebral body resembles the “filling,” thus creating a layered pattern reminiscent of a sandwich.
Pathophysiology
In osteopetrosis, defective osteoclastic resorption causes excessive bone deposition and sclerosis, especially at the vertebral endplates. This results in a marked contrast between the densely sclerotic endplates and the relatively normal cancellous bone in the vertebral body center, producing the characteristic sandwich vertebra appearance on radiographs.
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