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Chapter 87 

Chapter 87
Chapter 87

Eric Friedberg

and Paul Harkey

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date: 06 July 2022

An “ivory vertebra” refers to a diffusely dense vertebra by X-ray or CT that is otherwise normal (with preservation of vertebral body height and its contours). The adjacent intervertebral disc spaces are also preserved and unaffected. The patient’s age is useful in stratifying a differential diagnosis. In adults, depending on the history, the underlying etiology is often metastatic (common primary malignancies including prostate or breast cancer) or lymphoma. Paget disease is also important to consider, although it typically causes expansion of a vertebral body with trabecular thickening as well as a “picture frame vertebra” (sclerosis most prominent at the periphery of the vertebral body with a lucent center). Chronic infection can also result in an ivory vertebral body, but often the adjacent disc spaces are abnormal and the vertebral body endplates are irregular. Diffuse condensing osteoses can also result in this sign, such as fluorosis and osteopetrosis. Many of these conditions have associated systemic signs that help narrow the differential diagnosis. An ivory vertebral body is an uncommon entity in children, but when present tends to be secondary to lymphoma (usually Hodgkins), neuroblastoma, meduloblastoma, osteosarcoma, and, less commonly, osteoblastoma. Rarely, Ewing sarcoma can result in an ivory vertebral body.

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