Patterns of normal bone marrow distribution in the spine

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Patterns of normal bone marrow distribution in the spine have been described by Ricci . They apply to patients from the age of 6 months.

Gross anatomy

There are four patterns of normal red and yellow bone marrow distribution, with great variability not only between patients, but between respective spinal segments in a particular patient as well. The evolution of the infantile homogenous red marrow into pattern 1 is a constant feature of a normal pediatric marrow. The rest of the patterns are present in older individuals and do not follow any predictable evolution path.

Classification
  • pattern 1
    • yellow marrow visible around the basivertebral veins
    • ​​common in younger patients
    • may persist for years
  • pattern 2
    • ​band-like and triangular-like areas of yellow marrow in the vertebral body corners and adjacent to the endplates
    • may be affected by degenerative changes of the adjacent disc
  • pattern 3
    • speckled pattern: punctate foci of red and yellow bone marrow
  • pattern 4
    • ​​larger areas of yellow marrow and poorly circumscribed areas of red marrow

    • Practical points

    The knowledge of all four patterns is important in order to avoid mistaking them with spinal bone marrow pathology.