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American Journal of Roentgenology, Vol 97, 693-707, Copyright © 1966 by American Roentgen Ray Society

A RE-EVALUATION OF THE "FISH VERTEBRA" SIGN IN SICKLE CELL HEMOGLOBINOPATHY

JACK REYNOLDS M.D.1

1 From the Department of Radiology, University of Texas Southwestern Medical School, Dallas, Texas

The so-called fish vertebra deformity as manifest in sickle cell disease is shown to be different, both in contour and mode of development, from the familiar type of biconcave deformity commonly seen in the osteoporotic spine. The distinctive structural features which characterize this lesion are described. The deformity is unique in its local topography, its uniformity, and the manner in which it evolves.

Evidence based on a consideration of the contour of the defect and its location within the bone indicates that it is produced, not by the destruction and compression of existing bone like the common types of fish vertebra deformity, but by the local inhibition of bone growth as the result of regional ischemia. The "end-plates" of the growing centra where cupping takes place are functionally analogous to metaphyses, and the regional vascular anatomy is such that only the central portion of the growth plate suffers ischemic damage when circulation is impaired through the branches of the nutrient artery. These features control the shape of the deformity. The period during which the deformity evolves is closely correlated in time with the age of rapid growth, and this also marks the lesion as an aberration of bony development.

Although the "fish vertebra deformity" of sickle cell disease, as viewed roentgenographically, exhibits structural characteristics which can serve to distinguish it from the similar but not identical vertebral lesions produced by other disease entities, the diagnostic information provided by these unique morphologic features has never been properly exploited by the radiologist, despite the fact that the distinctive signs are virtually pathognomonic of the hemoglobinopathy.


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 Am. J. Roentgenol.Home page
M. E. Mulligan
Regarding "Fish" or "Fish Mouth" Vertebrae
Am. J. Roentgenol., June 1, 2004; 182(6): 1600 - 1600.
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