Lincoln Log (H-Shaped) Vertebra

One hundred years after Abraham Lincoln’s death, Jack Reynolds ¹ reviewed the spinal changes in sickle cell disease at the sixty-sixth annual meeting of the American Roentgen Ray Society (September 28October 1, 1965) held in Washington, DC. He considered usage of the term ‘codfish vertebra’ to describe the changes seen on spine radiographs of sickle cell patients unfortunate, since that term was originally intended to describe the spine changes of senile osteoporosis (see Codfish vertebra). ‘The use of the term in this context [senile osteoporosis] was well established when, rather recendy, it was first noted that cup-like depressions were present in the vertebral bodies of some patients with sickle cell disease’ ¹ (Figure 1). He said ‘while the two types of deformities differ … as yet, no substitute form of descriptive imagery has been fashioned to succincdy indicate the unique qualities of this stigma of the hemoglobinopathy.’ ¹ Later authors accepted this challenge and fashioned several descriptive terms such as step deformity ² , step-like ³ , step-off and H-shaped ⁴ . During my radiology residency, I learnt to use the term Lincoln log to describe this vertebral body deformity that is due to infarction of the central portion of the growth plate. It is not pathognomonic for sickle cell disease, as it has been described in patients with thalassemia and in patients with Gaucher’s disease. (Dr Reynolds agrees that the Lincoln log term is appropriate. He recalls that it was several years after his presentation when he first heard it used [Reynolds, personal communication].) Figure 1 ‘A portion of the thoracic spine of a young adult with sickle cell hemoglobinopathy in lateral projection. Near the center of each ‘endplate,’ the normal plane surface is deformed by a well defined, cup-like depression. Characteristically, both surfaces of each centrum exhibit identical depressions, and the shape of all of the involved segments is strikingly uniform.’ Reprinted from Reynolds’. A re-evaluation of the ‘fish vertebra’ sign in sickle cell hemoglobinopathy. <italic>Am. J. Roentgenol.,</italic> 97, 693–707, with the permission of the ARRS https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig49_1_B.jpg"/>