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Recently, while watching some imaging, my junior sister pointed out that a patient had a fissure in the middle of several vertebral bodies. What is this?
I was a bit puzzled by her sudden question. I’ve seen it a few times before but never paid much attention. During my research, I ruled out Modic changes and fatty deposition, and finally discovered that this is a blood vessel.
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There is a natural nourishing foramen located at the posterior margin of the vertebral body, between the pedicles, serving as a passage for the basivertebral vessels and nerves entering the vertebral body, called the basivertebral foramen.
Lumbar spine MRI clearly shows the basivertebral foramen, which appears triangular (circled).
Red: basivertebral nerve, Blue: vascular system
This special anatomical structure is rarely described in detail in domestic anatomy textbooks. It is important to note that the basivertebral veins passing through this foramen are closely related to vertebral body infections, metastases, and bone cement leakage during vertebroplasty. The basivertebral nerve is the transmitting nerve for vertebral body-originated pain (such as vertebral fractures) and endplate-originated pain (such as endplate injury). For more details, see: Discogenic low back pain, Nerve supply of lumbar vertebrae and endplates
Lumbar CT studies found that all lumbar vertebrae have basivertebral foramina, mainly in three shapes: triangular, rectangular, and irregular. Overall, the width of the lumbar basivertebral foramen increases gently with the vertebral body sequence, depth shows an increasing trend, and height shows a “wavy” pattern.
Basivertebral foramina seen on lumbar CT. A, D are triangular; B, E are rectangular; C, F are irregular.
Cadaveric dry specimen studies indicate that vertebral bodies do not only have a single basivertebral foramen; 54.9% of vertebrae have two or more basivertebral foramina.
Basivertebral foramina in cadaveric dry specimens. A: Single basivertebral foramen; B: Single basivertebral foramen divided into two parts by a bony bridge; C: Two basivertebral foramina; D-E: Three, four, and five basivertebral foramina, respectively.
References:
1. Tzika M, Paraskevas GK, Piagkou M, et al. Basivertebral foramina of true vertebrae: morphometry, topography and clinical considerations. Surg Radiol Anat 2021; 43:889-907.
2. Kang Xiaoyan, Xue Yongchun, Wang Xing, et al. CT multiplanar reconstruction observation of lumbar basivertebral foramen. Chinese Journal of Anatomy and Clinical 2015;20:302-5.
3. Lotz JC, Fields AJ, Liebenberg EC. The role of the vertebral end plate in low back pain. Global Spine J 2013;3:153-64.
Further Reading:
Basivertebral Foramen and Bone Cement Leakage
