What causes scalloped vertebrae in the spine on imaging?
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Answer:
Posterior scalloping of vertebral bodies is an exaggeration of the normal posterior vertebral body concavity, seen on lateral radiographs, CT, and MRI. It is caused by dural ectasia (as in Marfan syndrome, Ehlers-Danlos syndrome, and neurofibromatosis type 1 (NF1)), intraspinal masses (ependymoma, neurofibroma, dermoid/epidermoid cysts), chronically raised intraspinal pressure (e.g., hydrocephalus), and congenital skeletal dysplasias such as achondroplasia and the mucopolysaccharidoses, resulting in erosion of the posterior vertebral margins due to abnormal dural expansion, mass effect, or dysplastic bone remodeling.
Why is it called so?
Scalloped vertebrae refers to the smooth, concave erosion of the posterior vertebral body margins resembling the scalloped edges of a shell or pie crust.
Pathophysiology
Dural ectasia leads to focal dilation of the dural sac, exerting chronic pressure on adjacent bone causing posterior vertebral body scalloping; in NF1, this combines with mesodermal dysplasia and neurofibromas contributing to anterior/lateral scalloping, while mucopolysaccharidoses cause dysostosis multiplex with similar erosive changes, and achondroplasia produces scalloping via a combination of dural ectasia and short, thick pedicles narrowing the spinal canal.
Alternative names: Posterior vertebral body scalloping, vertebral scalloping.
Other associated named signs: Widened interpediculate distance; pedicle erosion.
References
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