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NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1754

Duplication of Lumbar Pedicle with A “Pseudo-foramen”: A Rare Anomaly


1 Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
2 Department of Radiology, National Neurosciences Centre, Calcutta, West Bengal, India

Date of Submission30-Nov-2020
Date of Decision15-Dec-2020
Date of Acceptance23-Dec-2020
Date of Web Publication30-Aug-2022

Correspondence Address:
Prasad Krishnan
Department of Neurosurgery, National Neurosciences Centre, 2nd Floor, Peerless Hospital Campus, 360, Panchasayar, Garia, Calcutta - 700 094, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.355109

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How to cite this article:
Bhosle R, Patel S, Das S, Krishnan P. Duplication of Lumbar Pedicle with A “Pseudo-foramen”: A Rare Anomaly. Neurol India 2022;70:1754

How to cite this URL:
Bhosle R, Patel S, Das S, Krishnan P. Duplication of Lumbar Pedicle with A “Pseudo-foramen”: A Rare Anomaly. Neurol India [serial online] 2022 [cited 2022 Oct 2];70:1754. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1754/355109




A 60-year-old lady presented to us with complaints of low back pain with no radicular symptoms. X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine showed an L5-S1 Grade 1 spondylolisthesis. At L4 level there was a duplication of the pedicle [Figure 1] and each of the two halves was thinner than corresponding pedicles above and below and enclosed a “pseudo foramen” in between. The disc space too though narrowed was patent and no radiological fusion of the vertebrae could be demonstrated. She was managed conservatively and no operative intervention was done.
Figure 1: (a) X-ray of lumbosacral spine showing duplication of the pedicle (blue arrows) at L4 level enclosing a pseudo-foramen in between. Each of the duplicated halves is smaller than a normal pedicle of vertebrae above and below. There is no fusion of the L3 and L4 bodies though disc space (orange arrow) is reduced; (b) magnetic resonance imaging (MRI) T2 sequence showing a Grade 1 spondylolisthesis of L5 over S1 in the sagittal section and (c) MRI in parasagittal section showing duplication of the pedicle (blue arrows)

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Duplication of the vertebral pedicles is an exceedingly rare anomaly and has been reported only once in the literature previously.[1] The vertebrae ossify from 3 primary centres of ossification––one in the centrum that gives rise to the vertebral body and 1 for each half of the neural arch that give rise to the pedicles, facets and laminae––starting at the sixth week of intrauterine life.[2] The end plates of each vertebral body, spinous process and tips of the transverse processes on the other hand arise by secondary ossification centres (beginning at puberty). We speculate that transient separation and later reunification of the primary ossification centres of the neural arch led to this radiological finding of duplicated pedicles. Though it is not known whether any root passes between the two parts of the pedicle through the “pseudo-foramen”, a surgeon encountering this condition must preoperatively determine the trajectory and size of the pedicle screw to be used if a vertebra with this anomaly needs to be included in the construct.

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  References Top

1.
Johnson R, Gustin PJ, Seibly JM. Duplication of vertebral pedicles associated with a thoracic burst fracture resulting in spinal cord compression: A case report. Cureus 2019;11:e3820.  Back to cited text no. 1
    
2.
Williams PL, Warwick R, Dyson M, Bannister LH. Gray's Anatomy. 37th ed. London: Churchill Livingstone; 1989. p. 159.  Back to cited text no. 2
    


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