Butterfly Vertebra¶

Definition¶

A butterfly vertebra is a congenital vertebral anomaly resulting from failure of fusion of the lateral chondrification centers of the vertebral body. This produces a sagittal cleft through the vertebral body, giving it a "butterfly" appearance on frontal (AP) radiograph or coronal CT. It is a benign incidental finding that requires no treatment.

Imaging Findings¶

Radiography¶

AP view — The vertebral body has a sagittal cleft, creating two lateral halves resembling butterfly wings. The endplates are concave toward the cleft.
Lateral view — Anterior notching or concavity of the vertebral body (the sagittal cleft is seen as an indentation)

CT¶

Coronal images — Sagittal cleft clearly demonstrated, with two hemivertebral bodies separated by a midline defect
Axial images — Midline sagittal cleft through the vertebral body

MRI¶

Not typically necessary for diagnosis
The cleft is visible on coronal images
Normal disc spaces above and below

Clinical Pearl

Butterfly vertebra is a benign incidental finding that can be confused with a vertebral body fracture (compression or burst) on lateral radiograph due to the anterior notching. The AP view resolves the diagnosis by showing the characteristic sagittal cleft. No follow-up or treatment is needed.

Key Points¶

Failure of fusion of lateral chondrification centers producing a sagittal cleft
Characteristic "butterfly" appearance on AP radiograph
Benign incidental finding — no treatment or follow-up needed
Anterior notching on lateral view can mimic fracture — AP view is diagnostic
Most common in the thoracic and lumbar spine

References¶

Gaillard F, et al. Butterfly vertebra. Radiopaedia.org. Available at: https://radiopaedia.org/articles/butterfly-vertebra. Accessed May 13, 2026.
Katsuura Y, Kim HJ. Butterfly vertebrae: a systematic review of the literature and analysis. Global Spine J. 2019;9(6):666-679. doi:10.1177/2192568218801016. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6693069/
Ozaras N, Gumussu K, Demir SE, Rezvani A. Differential diagnosis of multiple vertebral compression: butterfly vertebrae. J Phys Ther Sci. 2015;27(11):3601-3603. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4681953/
Boulet C, Schiettecatte A, De Mey J, De Maeseneer M. Case report: imaging findings in a "butterfly" vertebra. Acta Neurol Belg. 2011;111(4):344-348. Available at: https://pubmed.ncbi.nlm.nih.gov/22368979/
D'Amico A, Perillo T, Cuocolo R, Ugga L, Di Dato F, Caranci F, Iorio R. Neuroradiological findings in Alagille syndrome. Br J Radiol. 2022;95(1129):20201241. doi:10.1259/bjr.20201241. Available at: https://pubmed.ncbi.nlm.nih.gov/34609904/