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Vertebra plana (also called pancake vertebra) refers to flattening or collapse of the vertebral body, where the anterior and posterior heights are uniformly reduced, leading to an almost completely flattened vertebral body on lateral spinal imaging.
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Radiologic appearance:
| Feature | Description |
|---|---|
| Severe height loss | Nearly complete flattening of a vertebral body |
| Preserved intervertebral discs | Disc spaces often remain normal |
| No wedge deformity | Collapse is typically symmetric (anterior = posterior) |
| Sharp margins | May have sclerotic or healed appearance if chronic |
Langerhans cell histiocytosis in a 24-year-old male. (a) Cervical X-ray in lateral view shows vertebra plana in C4. (b) MRI of the cervical and thoracic spine demonstrates further vertebra plana in T8. Both vertebrae present flattening of the anterior body (with arrows) without compression of the spinal cord. (c) T1 sequence. (d) T2 sequence.
Angelini A, Mosele N, Gnassi A, Baracco R, Rodà MG, Cerchiaro M, Ruggieri P. Vertebra Plana: A Narrative Clinical and Imaging Overview among Possible Differential Diagnoses. Diagnostics. 2023; 13(8):1438. https://doi.org/10.3390/diagnostics13081438
Langerhans cell histiocytosis (eosinophilic granuloma) in a 14-year-old male. (a) Lumbosacral radiograph shows vertebra plana in L2. (b) trocar biopsy and histologic evaluation (high power hematoxylin and eosin view—original magnification ×40) confirmed the diagnosis: a clonal proliferation of cells that morphologically and immunophenotypically resemble Langerhans cells (c) complete healing and restoration of the vertebral body at 6 years after intralesional corticosteroid injection.
Angelini A, Mosele N, Gnassi A, Baracco R, Rodà MG, Cerchiaro M, Ruggieri P. Vertebra Plana: A Narrative Clinical and Imaging Overview among Possible Differential Diagnoses. Diagnostics. 2023; 13(8):1438. https://doi.org/10.3390/diagnostics13081438
Vertebra plana results from complete collapse of the vertebral body, due to either:
Common causes of vertebra plana:
| Etiology Category | Conditions |
|---|---|
| Neoplastic (most common) | ‣ (most classic in children) |
| Ewing sarcoma, leukemia, lymphoma, metastases | |
| Infectious | Spinal tuberculosis (Pott disease), pyogenic spondylitis |
| Traumatic | Pathologic vertebral compression fracture (especially in osteoporosis) |
| Metabolic/others | Osteogenesis imperfecta, eosinophilic granuloma (LCH subtype) |
| Age Group | Common Causes |
|---|---|
| Children | LCH (eosinophilic granuloma), leukemia, trauma, infection |
| Adults | Osteoporosis, metastasis (breast, lung, prostate), myeloma, TB |
| Any age | Trauma, metabolic bone disease |
The mnemonic HEIGHT OF HOMO summarizes all possible differential diagnoses for vertebra plana.
Angelini A, Mosele N, Gnassi A, Baracco R, Rodà MG, Cerchiaro M, Ruggieri P. Vertebra Plana: A Narrative Clinical and Imaging Overview among Possible Differential Diagnoses. Diagnostics. 2023; 13(8):1438. https://doi.org/10.3390/diagnostics13081438
| Symptom | Description |
|---|---|
| Back pain | Focal tenderness or dull ache |
| Neurologic deficits | If there is spinal cord or nerve root compression |
| Spinal deformity | Kyphosis or scoliosis in chronic cases |
| Systemic symptoms | Fever, weight loss (if infectious/neoplastic) |