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"Fish" or "Fish Mouth" Vertebrae?

National Naval Medical Center, Bethesda, MD 20889 Walter Reed Army Medical Center, Washington, DC 20307

Editor's Note.—Personally, I have long referred to this vertebral deformity as a "codfish vertebra." The origin for the "codfish" designation is not known. However, the addition of the word "cod" makes the phrase not only more rhythmic but more memorable.

Debate was recently sparked after a case conference during which the case of an elderly woman with osteoporosis was shown to have multilevel biconcavities of the superior and inferior end plates of her lower thoracic spine. One group of residents characterized the finding as "fish mouth" vertebrae and a second group of residents noted the finding to be "fish" vertebrae. A search of the literature and of several radiology textbooks revealed the use of both terms, with essentially the same definition given in each case (biconcave vertebrae).

By way of further investigation, we obtained a salmon spine at a local fish market and brought to the radiology department for evaluation. We submit two radiographs, the first taken from the lateral chest radiograph of a young patient with sickle cell disease (Fig. 3) and the second that shows the appearance of the salmon spine (Fig. 4). The biconcavity seen at the superior and inferior end plates of the patient's osteoporotic vertebral bodies most closely resembles the normal appearance of the fish spine and not the appearance of the fish mouth. Dr. Resnick's paper makes similar observations using radiographs of the tuna spine [2].

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3. —12-year-old boy with sickle cell disease. Coned-down view of lateral chest radiograph reveals mid and lower thoracic spine as fish vertebrae. Note smooth and symmetric biconcavities of superior and inferior vertebral end plates at multiple levels.

View larger version (42K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4. —Salmon fish. Specimen radiograph of spine of salmon reveals normal multilevel biconcavity extending through superior and inferior vertebral end plates.

Finally, some residents have pointed out that their use of fish mouth refers to the biconvex appearance of the patient's intervertebral disk spaces. In these instances, then, we recommend consideration of phrases such as fish mouth disk spaces or fish mouth spine because the use of fish mouth vertebrae implies a description of the shape of the vertebral bodies as opposed to the configuration of the intervertebral disks.

References

1. Chan KK, Sartoris DJ, Haghighi P, et al. Cupid's bow contour of the vertebral body: evaluation of pathogenesis with bone densitometry and imaging-histopathologic correlation. Radiology1997; 202:253 -256[Abstract/Free Full Text]
2. Resnick D. Fish vertebrae. Arthritis Rheum1982; 25:1073 -1077[Medline]

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