1 Pages

Ivory Vertebra

WithMichael E. Mulligan

The lead article in the Revue Neurologique in January 1925 was the report of the ‘vertèbre d’ivoire’ by Alexandre Souques and co-workers 1 . Their patient was a 57-year-old woman with breast cancer who had progressive weakening of her leg strength (or muscle strength). A radiographic examination of the thoracic spine showed a uniformly white T6 vertebra with no abnormality of its contour or adjacent disks (Figure 1). Lipiodol myelogram revealed a complete block at this level. They were reluctant to diagnose this abnormality as metastatic involvement since the patient had no other signs or symptoms of metastatic disease. (Oscar Batson’s work demonstrating the venous connections to the paravertebral plexus from the deep pelvic veins and shoulder girdle would not be published until 1940 2 .) Nevertheless their conclusion was that this ivory vertebra did indeed represent metastatic involvement. Joseph Re’camier introduced the term metastasis to describe the spread of cancer in 1829 3 . Even today the two most common causes of ivory vertebrae are metastatic disease (especially from breast cancer and Hodgkin’s disease) and Paget’s disease. ‘Radiograph of the sixth dorsal vertebra, white by convention and black on the film; this vertebra is remarkable for the integrity of its form and volume, and for the uniformity of its coloring.’ (Film done 6 weeks after lipiodol myelogram.) Reprinted from Souques et <italic>al</italic> Vertèbre ‘d’ivoire’ dans un can de cancer metas-tatique de la colonne vertebrale. Rev. <italic>Ne</italic>u<italic>vol.</italic> 32, 3–10 with permission of Masson-Periodiques