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Choi M, Jang JS. Heatmap-Based Active Shape Model for Landmark Detection in Lumbar X-ray Images. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01210-x. [PMID: 39103566 DOI: 10.1007/s10278-024-01210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 08/07/2024]
Abstract
Medical staff inspect lumbar X-ray images to diagnose lumbar spine diseases, and the analysis process is currently automated using deep-learning techniques. The detection of landmarks is necessary in the automatic process of localizing the position and identifying the morphological features of the vertebrae. However, detection errors may occur owing to the noise and ambiguity of images, as well as individual variations in the shape of the lumbar vertebrae. This study proposes a method to improve the robustness of landmark detection results. This method assumes that landmarks are detected by a convolutional neural network-based two-step model consisting of Pose-Net and M-Net. The model generates a heatmap response to indicate the probable landmark positions. The proposed method then corrects the landmark positions using the heatmap response and active shape model, which employs statistical information on the landmark distribution. Experiments were conducted using 3600 lumbar X-ray images, and the results showed that the landmark detection error was reduced by the proposed method. The average value of maximum errors decreased by 5.58% after applying the proposed method, which combines the outstanding image analysis capabilities of deep learning with statistical shape constraints on landmark distribution. The proposed method could also be easily integrated with other techniques to increase the robustness of landmark detection results such as CoordConv layers and non-directional part affinity field. This resulted in a further enhancement in the landmark detection performance. These advantages can improve the reliability of automatic systems used to inspect lumbar X-ray images. This will benefit both patients and medical staff by reducing medical expenses and increasing diagnostic efficiency.
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Affiliation(s)
- Minho Choi
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea
| | - Jun-Su Jang
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea.
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Ouchida J, Nakashima H, Kanemura T, Tsushima M, Ito S, Segi N, Tomita H, Morishita K, Oyama H, Oshima K, Imagama S. Analysis of spinopelvic parameters in adult patients with lumbosacral transitional vertebrae. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2952-2959. [PMID: 38922415 DOI: 10.1007/s00586-024-08378-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Spinopelvic sagittal alignment is crucial for assessing balance and determining treatment efficacy in patients with adult spinal deformity (ASD). Only a limited number of reports have addressed spinopelvic parameters and lumbosacral transitional vertebrae (LSTV). Our primary objective was to study spinopelvic sagittal parameter changes in patients with LSTV. A secondary objective was to investigate clinical symptoms and quality of life (QOL) in patients with LSTV. METHODS In this study, we investigated 371 participants who had undergone medical check-ups for the spine. LSTV was evaluated using Castellvi's classification, and patients were divided into LSTV+ (type II-IV, L5 vertebra articulated or fused with the sacrum) and LSTV- groups. After propensity score matching for demographic data, we analyzed spinopelvic parameters, sacroiliac joint degeneration, clinical symptoms, and QOL for these two participant groups. Oswestry Disability Index (ODI) scores and EQ-5D (EuroQol 5 dimensions) indices were compared between the two groups. RESULTS Forty-four patients each were analyzed in the LSTV + and LSTV- groups. The LSTV + group had significantly greater pelvic incidence (52.1 ± 11.2 vs. 47.8 ± 10.0 degrees, P = 0.031) and shorter pelvic thickness (10.2 ± 0.9 vs. 10.7 ± 0.8 cm, P = 0.018) compared to the LSTV- group. The "Sitting" domain of ODI (1.1 ± 0.9 vs. 0.6 ± 0.7, P = 0.011) and "Pain/Discomfort" domain of EQ-5D (2.0 ± 0.8 vs. 1.6 ± 0.7, P = 0.005) were larger in the LSTV + group. CONCLUSION There was a robust association between LSTV and pelvic sagittal parameters. Clinical symptoms also differed between the two groups in some domains. Surgeons should be aware of the relationship between LSTV assessment, radiographic parameters and clinical symptoms. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan.
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Sadayuki Ito
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Hiroyuki Tomita
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kazuaki Morishita
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Hiroki Oyama
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kazuma Oshima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
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Rädel B, James Paton G. The Clinical Significance of Lumbar Transverse Process Lengths Associated with Lumbosacral Transitional Vertebrae: A Landmark for Lumbar Spine Enumeration. World Neurosurg 2024:S1878-8750(24)00940-9. [PMID: 38843967 DOI: 10.1016/j.wneu.2024.05.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE This study aimed to identify which lumbar vertebral level above a lumbosacral transitional vertebra (LSTV) demonstrated the longest transverse process (TVP) lengths. METHODS In this exploratory quantitative osteological cohort study using a digital Vernier caliper, dried human cadaveric lumbar TVPs were measured for linear horizontal length at each lumbar vertebra, left and right sides. Data collection was conducted in South Africa at the Raymond A. Dart Collection of Modern Human Skeletons and the Pretoria Bone Collection. The LSTV cohort consisted of 110 spinal columns and an LSTV-free control cohort of a sex-balanced randomized selection of 30 male and 30 female spinal columns. RESULTS Compared with the control cohort, the LSTV cohort demonstrated longer TVPs for every vertebral level, particularly L3, while the left side demonstrated longer TVPs overall. There were no statistical differences in TVP length within the LSTV cohort when comparing all levels (P > 0.05). The L3 TVPs demonstrated the longest mean lengths in both control (65%) and LSTV (58%) cohorts. The general trend was that the TVPs of L3 had the longest mean length for both the left and the right sides in both cohorts and both sexes. CONCLUSIONS In the absence of whole-spine imaging, these findings indicate that L3 TVPs may offer an alternative bony landmark, which may aid in spinal enumeration estimation in the setting of LSTV. This is of value for radiograph appraisal and may aid with correct-level intervention.
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Affiliation(s)
- Bianca Rädel
- Faculty of Health Sciences, Department of Chiropractic, University of Johannesburg, Johannesburg, South Africa
| | - Glen James Paton
- Faculty of Health Sciences, Department of Chiropractic, University of Johannesburg, Johannesburg, South Africa.
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Covasa CT. Transitional, fused and/or supernumerary vertebrae in the lumbosacrocaudal region of the spine - A reality in many domestic mammals. VET MED-CZECH 2024; 69:156-168. [PMID: 38841130 PMCID: PMC11148713 DOI: 10.17221/102/2023-vetmed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/28/2024] [Indexed: 06/07/2024] Open
Abstract
The aim of this study was to identify the presence of transitional lumbosacral and sacrocaudal vertebrae in domestic mammals, to realise a comparative analysis of the localisation and conformation of this abnormal condition. The research included the following species: cattle - 29 specimens, sheep - 32 specimens, horse - 31 specimens, pig - 26 specimens, rabbit - 33 specimens, dog - 89 specimens and cat - 57 specimens. The spine of the animals was analysed post-mortem or radiologically. The investigations revealed the presence of transitional vertebrae as follows: in cattle - 3 cases (8.7%), all being about the lumbarisation of the first sacral vertebra (S1); in sheep - 3 cases (9.37%), two lumbarisation cases of S1 and one caudalisation of S4 (the last sacral vertebra); in horses - 4 cases (12.9%), all about the sacralisation of Cd1 (first caudal vertebra); in pigs - 3 cases (11.53%), two lumbarisation cases of S1 and one sacralisation of Cd1; in rabbits - 3 cases (9.09%), a lumbar supernumerary vertebra (L8) and two cases of caudalisation of S4; in dogs - 4 cases (4.49%), a lumbar supernumerary vertebra (L8) and 3 cases of sacralisation of the last lumbar vertebra (L7 or L8); in cats - 3 cases (5.26%), two sacralisation cases of the last lumbar vertebra and one case of caudalisation of the last sacral vertebra (S3). A strong lumbarisation process was observed in ruminants (especially in cattle), then in pigs, the sacralisation being prevalent in carnivores. The sacrocaudal transitional vertebra was predominant in horses. No evident influence of the sex and age of the animals was observed.
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Affiliation(s)
- Costica Toader Covasa
- Department of Preclinics, Faculty of Veterinary Medicine, University of Life Sciences, Iasi, Romania
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Bhagchandani C, Murugan C, Arumugam T, Karuppanan Sukumaran SVA, Shetty AP, Kanna RM, Rajasekaran S. A Whole-Spine Magnetic Resonance Imaging-Based Cross-Sectional Study of the Clinicoradiological Association of Lumbosacral Transitional Vertebra with Degenerative Disc Disease, End Plate Degeneration, Low Back Pain, and Facet Tropism. World Neurosurg 2024; 185:e1121-e1128. [PMID: 38492662 DOI: 10.1016/j.wneu.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To understand lumbosacral transitional vertebra (LSTV)-associated degenerative pathologies and their correlation to low back pain and radicular pain. METHODS Whole-spine magnetic resonance imaging was evaluated for disc degeneration using Pfirrmann grading, end plate changes using total end plate score (TEPS), and facet tropism in patients with low back pain and radicular pain, and their association with LSTV was analyzed. RESULTS In group 1, LSTV was seen in 15% of patients with 83% of these patients having sacralization. Disc degeneration was seen in 58%, 51%, and 63% of patients at levels C, B, and A, respectively; patients with sacralization had significant degeneration at all 3 levels. Similarly, the total end plate score and facet tropism were significantly higher in patients with sacralization. Facet tropism was observed in 31%, 40%, and 35% of patients with no -LSTV, patients with sacralization, and patients with lumbarization, respectively. In group 2, LSTV was seen in 17% of patients with sacralization accounting for 82%. Disc degeneration was seen in 44%, 36%, and 54% patients at levels C, B, and A, respectively. No significant difference was observed in the mean total end plate score between groups. Facet tropism was identified in 89% and 81% of patients with sacralization and patients with lumbarization, respectively, compared with only 19% of patients with no LSTV. CONCLUSIONS Patients with low back pain had a higher incidence of sacralization with corresponding disc degeneration, facet tropism ,and end plate changes. In patients with radicular pain, lumbarization was associated only with facet tropism. These findings may aid clinicians in prognostication and patient counseling.
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Affiliation(s)
| | - Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Thirumurugan Arumugam
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | | | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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Iplikcioglu AC, Karabag H. A simple method for the selection of valid spinopelvic parameters and lumbar lordosis in patients with transitional lumbosacral vertebrae. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1821-1829. [PMID: 38554154 DOI: 10.1007/s00586-024-08220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/13/2024] [Accepted: 03/07/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE Transitional lumbosacral vertebrae (TLSV) are a congenital anomaly of the lumbosacral region that is characterized by the presence of a vertebra with morphological properties of both the lumbar and sacral vertebrae, with a prevalence of up to 36% in asymptomatic patients and 20% in adolescent idiopathic scoliosis patients. In patients with TLSV, because of these morphological changes and the different numbers of lumbar vertebrae, there are two optional reference sacral endplates that can be selected intently or inadvertently to measure the spinopelvic parameters: upper and lower endplates. The spinopelvic parameters measured using the upper and lower endplates are significantly different from each other as well as from the normative values. Therefore, the selection of a reference endplate changes the spinopelvic parameters, lumbar lordosis (LL), and surgical goals, which can result in surgical over- or under-correction. Because there is no consensus on the selection of sacral endplate among these patients, it is unclear as to which of these parameters should be used in diagnosis or surgical planning. The present study describes a standardization method for measuring the spinopelvic parameters and LL in patients with TLSV. METHODS Upper and lower endplate spinopelvic parameters (i.e., pelvic incidence [PI], sacral slope [SS], and pelvic tilt) and LL of 108 patients with TLSV were measured by computed tomography. In addition, these parameters were measured for randomly selected subjects without TLSV. The PI value in the TLSV group, which was closer to the mean PI value of the control group, was accepted as valid and then used to create an optimum PI (OPI) group. Finally, the spinopelvic parameters and LL of the OPI and control groups were compared. RESULTS Except for SS, all spinopelvic parameters and LL were comparable between the OPI and control groups. In the OPI group, 60% of the patients showed valid upper endplate parameters, and 40% showed valid lower endplate parameters. No difference was noted in the frequency of valid upper or lower endplates between the sacralization and lumbarization groups. Both the OPI and control groups showed nearly comparable correlations between their individual spinopelvic parameters and LL, except for PI and LL in the former. CONCLUSIONS Because PI is unique for every individual, the endplate whose PI value is closer to the normative value should be selected as the reference sacral endplate in patients with TLSV.
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Affiliation(s)
| | - Hamza Karabag
- Department of Neurosurgery, Faculty of Medicine, Harran University, Şanlıurfa, Turkey.
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Karabag H, Iplikcioglu AC. Analysis of Spinopelvic Parameters and Lumbar Lordosis in Patients with Transitional Lumbosacral Vertebrae, with Special Reference to Sacralization and Lumbarization. World Neurosurg 2024; 183:e900-e908. [PMID: 38218445 DOI: 10.1016/j.wneu.2024.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Transitional lumbosacral vertebra presents in 2 forms based on its origin: sacralization and lumbarization. These patients have 2 options for sacral endplates (upper and lower) and consequently, 2 sets of values for spinopelvic parameters and lumbar lordosis (LL). This study aimed to evaluate these parameters in asymptomatic patients with sacralization and lumbarization and compare them with each other and normative values. METHODS Spinopelvic parameters and LL according to upper and lower endplate were measured using abdominal computed tomography in 1420 asymptomatic patients, of which 108 had Transitional lumbosacral vertebra. These parameters were compared among patients with lumbarization and sacralization and with normal controls. In addition, correlations between the upper and lower endplate parameters were determined. RESULTS As compared to the control group, upper endplate measurements yielded lower spinopelvic parameters and LL values while lower endplate values yielded higher values. While these values were significantly different from normative values, these parameters were similar in both lumbarization and sacralization groups. Furthermore, most spinopelvic parameters of both upper and lower endplates were strongly correlated, and the differences between the upper and lower PI and LL values are relatively constant (27° and 14°, respectively. CONCLUSIONS Upper and lower endplate parameters are comparable in patients with sacralization and lumbarization; therefore, the average spatial position of a sacralized L5 and a lumbarized S1 within the pelvis is similar and either parameter can be used for radiological measurements. Further studies with symptomatic patients are warranted to confirm these results.
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Affiliation(s)
- Hamza Karabag
- Department of Neurosurgery, Faculty of Medicine, Harran Üniversity, Şanlıurfa, Turkey.
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Vu PD, Robinson CL, Viswanath O, Urits I, Hasoon J. Techniques in medicine: ipsilateral transforaminal epidural steroid injection in Bertolotti's syndrome. Pain Manag 2024; 14:125-128. [PMID: 38385170 DOI: 10.2217/pmt-2023-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Bertolotti's syndrome, also known as lumbosacral transitional vertebrae, is a relatively rare spinal condition characterized by an anatomical variation in the lower spine. Conservative approaches such as physical therapy, anti-inflammatory medications and lifestyle modifications may be recommended for mild cases. In more severe cases or when conservative measures fail to provide relief, injections such as may be considered to alleviate pain. This case is unique in that we document a challenging technique of ipsilateral transforaminal epidural steroid injection in a patient with Bertolotti's syndrome.
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Affiliation(s)
- Peter D Vu
- UTHealth McGovern Medical School, Department of Physical Medicine & Rehabilitation, Houston, TX 77030, USA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, & Pain Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Omar Viswanath
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA 71103, USA
| | - Ivan Urits
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA 71103, USA
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesia & Pain Medicine, Houston, TX 77030, USA
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Becker L, Mihalache TV, Schmidt H, Putzier M, Pumberger M, Schömig F. Influences of lumbo-sacral transitional vertebrae for anterior lumbar interbody fusion. Sci Rep 2024; 14:2746. [PMID: 38302558 PMCID: PMC10834422 DOI: 10.1038/s41598-024-53179-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
Lumbo-sacral transitional vertebrae (LSTV) are frequent congenital variances of the spine and are associated with increased spinal degeneration. Nevertheless, there is a lack of data whether bony alterations associated with LSTV result in reduced segmental restoration of lordosis when performing ALIF. 58 patients with monosegmental stand-alone ALIF in the spinal segment between the 24th and 25th vertebra (L5/S1)/(L5/L6) where included. Of these, 17 patients had LSTV and were matched to a control population by age and sex. Pelvic incidence, pelvic tilt, sagittal vertical axis, lumbar lordosis, segmental lordosis, disc height and depth were compared. LSTV-patients had a significantly reduced segmental lordosis L4/5 (p = 0.028) and L5/S1/(L5/L6) (p = 0.041) preoperatively. ALIF resulted in a significant increase in segmental lordosis L5/S1 (p < 0.001). Postoperatively, the preoperatively reduced segmental lordosis was no longer significantly different in segments L4/5 (p = 0.349) and L5/S1/(L5/6) (p = 0.576). ALIF is associated with a significant increase in segmental lordosis in the treated segment even in patients with LSTV. Therefore, ALIF is a sufficient intervention for restoring the segmental lordosis in these patients as well.
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Affiliation(s)
- Luis Becker
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353, Berlin, Germany.
| | - Tim Victor Mihalache
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Hendrik Schmidt
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Michael Putzier
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353, Berlin, Germany
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Coskun Benlidayi I, Tirasci E. The effect of lumbosacral transitional vertebra on lumbar spine degeneration and spondylolisthesis among patients with low back pain. Pain Pract 2024; 24:52-61. [PMID: 37497739 DOI: 10.1111/papr.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
AIM To examine the impact of lumbosacral transitional vertebra (LSTV) on lumbar spine degeneration, disc protrusion, and spondylolisthesis among patients with low back pain. METHODS The records of the patients who had undergone anterioposterior lumbar radiographs and lumbar magnetic resonance imaging (MRI) for low back pain between November 2014 and September 2021 were extracted retrospectively and assessed for eligibility. Of the remaining patients, those with LSTV were assigned as "case group." Age- and sex-matched patients without LSTV were assigned as "control group." On digitalized lumbar MRIs, Modic degeneration (type I-III) and Pfirrman's disc degeneration (grade I-V) immediately cephalad to the transitional level were evaluated; intervertebral disc height (mm), disc protrusion (mm), and percentage of vertebral slippage (%) were measured. RESULTS Of the 501 patients with low back pain, 128 ineligible patients were excluded; 113 patients with LSTV and 117 age- and sex-matched controls were included in the study. LSTV group revealed decreased intervertebral disc height, increased vertebral endplate degeneration, and slippage, as well as increased disc degeneration and protrusion when compared with controls (p < 0.001). Patients with type III LSTV had greater disc protrusion and higher percentage of slippage compared to those with type I LSTV (p = 0.008 and p = 0.009, respectively). Vertebral endplate degeneration, disc height, and disc degeneration did not differ across categories of LSTV type. CONCLUSION Lumbosacral transitional vertebra malformation is related to decreased intervertebral disc height, increased disc degeneration, vertebral endplate degeneration, disc protrusion, and slippage above the level of transition. Patients with type III LSTV revealed the highest percentage of slippage and disc protrusion.
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Affiliation(s)
- Ilke Coskun Benlidayi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Emre Tirasci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey
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Chiu CK, Chin TF, Chung WH, Chan CYW, Kwan MK. Variations in the Number of Vertebrae, Prevalence of Lumbosacral Transitional Vertebra and Prevalence of Cervical Rib Among Surgical Patients With Adolescent Idiopathic Scoliosis: An Analysis of 998 Radiographs. Spine (Phila Pa 1976) 2024; 49:64-70. [PMID: 37146062 DOI: 10.1097/brs.0000000000004711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN Retrospective Study. OBJECTIVE This study aims to investigate variation in the number of thoracic and lumbar vertebrae, the prevalence of lumbosacral transitional vertebra (LSTV) and the prevalence of cervical ribs among surgical patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Due to variation in the number of thoracic or lumbar vertebrae, inaccurate identification of vertebral levels has been found to be a contributory factor to wrong-level surgery. METHODS This was a retrospective study on AIS patients who underwent posterior spinal fusion. Demographic and anthropometric data (age, gender, height, weight, and body mass index), radiographic data (Lenke curve type, pre-operative Cobb angle, vertebra numbering of cervical, thoracic, and lumbar spine, presence of LSTV based on the Castellvi classification and the presence of cervical ribs) and clinical data were collected. Data were analysed and reported with mean and standard deviation for quantitative parameters and number and percentage for qualitative parameters. Multinomial logistic regression analyses were performed to identify factors associated with the outcomes of interest. RESULTS A total of 998 patients met inclusion criteria, of which 135 (13.5%) were males and 863 (86.5%) were females. The vertebrae number varied between 23 to 25 total vertebrae with 24 vertebrae considered as the typical number of vertebrae. The prevalence of atypical number of vertebrae (23 or 25) was 9.8% (98 patients). We found a total of 7 different variations in number of cervical, thoracic, and lumbar vertebrae (7C11T5L, 7C12T4L, 7C11T6L, 7C12T5L, 7C13T4L, 7C12T6L, and 7C13T5L) with 7C12T5L considered as the typical vertebrae variation. The total prevalence of patients with atypical vertebrae variation was 15.5% (155 patients). Cervical ribs were found in 2 (0.2%) patients while LSTV were found in 250 (25.1%) of patients. The odds of 13 thoracic vertebrae were higher in males (OR 5.17; 95% CI: 1.25, 21.39) and the odds of 6 lumbar vertebrae were higher in LSTV (OR 3.93; 95% CI: 2.58, 6.00). CONCLUSION In this series, we identified a total of 7 different variations in the number of cervical, thoracic, and lumbar vertebrae. The total prevalence of patients with atypical vertebrae variation was 15.5%. LSTV was found in 25.1% of the cohort. It is important to ascertain atypical vertebrae variations rather than the absolute number of vertebrae because variants such as 7C11T6L and 7C13T4L may still have typical numbers of vertebrae in total. However, due to the differences in the number of morphologically thoracic and lumbar vetrebrae, there may still be a risk of inaccurate identification.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur
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12
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Lam CSA, Weber MD, Patel MS, Jin A, Grossbach AJ. Letter: Transitional Anatomy Considerations in Spinal Deformity Surgery. Neurosurgery 2023; 93:e137-e138. [PMID: 37668371 DOI: 10.1227/neu.0000000000002658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023] Open
Affiliation(s)
- Chi Shing Adrian Lam
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Matthieu D Weber
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Mayur S Patel
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Abbey Jin
- Department of Neurology, University of Missouri - Kansas City School of Medicine, St. Joseph , Missouri , USA
| | - Andrew J Grossbach
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus , Ohio , USA
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Ali M, Enchev Y. A rare cause of low back pain in adolescence - Bertolotti syndrome: A case report. Surg Neurol Int 2023; 14:383. [PMID: 37941609 PMCID: PMC10629326 DOI: 10.25259/sni_762_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
Background Bertolotti syndrome (BS) is defined as a congenital anomaly of the spine that includes sacralization of the lowest lumbar vertebra or lumbarization of the first sacral vertebra (i.e., lumbosacral transitional vertebra- LSTV) and the pain associated with this condition. The incidence of BS in adolescence is rare; we found only three such case reports of patients under the age of 18 in the literature, here will add a fourth. Case Description A 17-year-old female presented with a 2-month history of low back pain exacerbated by physical activity. Her neurological examination was normal, except for pain elicited when applying pressure over the sacroiliac joints bilaterally, and over the spinous process of the L5 vertebra. The computed tomography scan documented BS: (i.e., LSTV - Castellvi classification: Type IIa on the left side). She was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone. Conclusion Here, we report a 17-year-old female who was symptomatic from BS and was successfully treated with NSAIDs.
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Affiliation(s)
- Mustafa Ali
- Department of Neurosurgery and Ear, Nose and Throat Diseases, Division of Neurosurgery, Medical University of Varna, Varna, Bulgaria
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14
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Zhu W, Ding X, Zheng J, Zeng F, Zhang F, Wu X, Sun Y, Ma J, Yin M. A systematic review and bibliometric study of Bertolotti's syndrome: clinical characteristics and global trends. Int J Surg 2023; 109:3159-3168. [PMID: 37318877 PMCID: PMC10583961 DOI: 10.1097/js9.0000000000000541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Bertolotti's syndrome is a prevalent congenital deformity. However, many physicians fail to include it in their differential diagnosis for low back pain (LBP), which results in missed diagnosis or misdiagnosis. There is still a lack of standardized treatment and management strategies for Bertolotti's syndrome. This study aimed to review the clinical characteristics and management of Bertolotti's syndrome and reports bibliometric insights in advancements in Bertolotti's syndrome research. METHODS Studies published until 30 September 2022 were systematically reviewed according to the PRISMA guidelines. Three independent reviewers extracted the data and assessed the quality and risk of bias of the studies based on the methodological index of non-randomized studies (MINORS). SPSS, VOS viewer, and the Citespace software were used for the systematic review, visual analysis, data mining, mapping, and clustering of the retrieved articles, which presented clear and visual presentations of the structural patterns of published research in graphs. RESULT A total of 118 articles, describing a total of 419 patients with Bertolotti's syndrome, were included. There was an upward trend with a steady increase in the number of publications. The world map distribution showed that most publications were predominantly from North America and Asia. The most cited articles were published in the following journals: Spine, J Bone Joint Surg, and Radiology. The mean age of the patients was 47.7 years, and 49.6% of them were male. A total of 159 (96.4%) patients had LBP symptoms. The mean symptom duration was 41.4 months (74.8%), and most of the patients had Castellvi type II. Disc degeneration was the most reported comorbid spinal diseases. The mean methodological index of non-randomized studies score was 4.16±3.95 points (range, 1-21). A total of 265 (68.3%) patients underwent surgical treatments. Minimally invasive surgical techniques, prevalence, image classification, and disc degeneration were the current main research areas of Bertolotti's syndrome. CONCLUSIONS The steady increase in the number of publications demonstrated the increased attention of researchers on this topic. Our results showed a significant prevalence of Bertolotti's syndrome in patients with LBP and a long symptom duration before the initiation of treatment. Surgical treatments were commonly used to treat patients with Bertolotti's syndrome after a non-effective conservative treatment. Minimally invasive surgical techniques, prevalence, image classification, and disc degeneration are the major research areas of Bertolotti's syndrome.
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Affiliation(s)
- Wenhao Zhu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Xing Ding
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Jiale Zheng
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Fan Zeng
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Fan Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Xuequn Wu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Yijun Sun
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
| | - Junming Ma
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Mengchen Yin
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
- Postdoctoral Station, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Becker L, Hipfl C, Schömig F, Perka C, Hardt S, Pumberger M, Leopold VJ. The influence of lumbo-sacral transitional vertebrae in developmental dysplasia of the hip: a matched pair analysis. Sci Rep 2023; 13:10027. [PMID: 37340098 DOI: 10.1038/s41598-023-37208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/18/2023] [Indexed: 06/22/2023] Open
Abstract
Lumbo-sacral transitional vertebrae (LSTV) are the most common congenital alteration of the lumbo-sacral junction and known to significantly influence pelvic anatomy. However, the influence of LSTV on dysplasia of the hip (DDH) and the surgical treatment by periacetabular osteotomy (PAO) remains unknown. We retrospectively examined standardized standing anterior-posterior pelvic radiographs of 170 patients in 185 PAO procedures. Radiographs were examined for LSTV, lateral-central-edge-angle (LCEA), Tönnis-angle (TA), femoral-head-extrusion index (FHEI), and anterior-wall-index (AWI) and posterior-wall-index (PWI). Patients with LSTV were compared to an age- and sex-matched control group. Patient-reported outcome measurements (PROMs) were evaluated pre- and in the mean 63.0 months (range 47-81 months) postoperatively. 43 patients (25.3%) had LSTV. Patients with LSTV had significantly greater PWI (p = 0.025) compared to the matched control group. No significant differences were seen in AWI (p = 0.374), LCEA (p = 0.664), TA (p = 0.667), and FHEI (p = 0.886). Between the two groups, no significant differences were detected in pre- or postoperative PROMs. Due to the increased dorsal femoral head coverage in patients with LSTV and DDH compared to patients with sole DDH, a more pronounced ventral tilting might be performed in those patients with prominent posterior wall sign to avoid anterior undercoverage, which is a significant predictor for premature conversion to hip arthroplasty after PAO. However, anterior overcoverage or acetabular retroversion must be avoided due to the risk of femoroacetabular impingement. Patients with LSTV reported similar functional outcomes and activity after PAO as the control group. Therefore, even for patients with concomitant LSTV, which are frequent with one-fourth in our cohort, PAO is an efficient treatment option to improve clinical symptoms caused by DDH.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Vincent Justus Leopold
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Yamauchi I, Nakashima H, Machino M, Ito S, Segi N, Tauchi R, Ohara T, Kawakami N, Imagama S. Relationship between lumbosacral transitional vertebra and postoperative outcomes of patients with Lenke 5C adolescent idiopathic scoliosis: a minimum 5-year follow-up study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2221-2227. [PMID: 37140639 DOI: 10.1007/s00586-023-07752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To assess the incidence of lumbosacral transitional vertebra (LSTV) in Lenke 5C adolescent idiopathic scoliosis (AIS) and evaluate the relationship between postoperative outcomes and LSTV when the lowest instrumented vertebra (LIV) is fixed at L3. METHODS The study included 61 patients with Lenke 5C AIS who underwent fusion surgery of L3 as the LIV who were followed-up for a minimum of 5 years. Patients were divided into two groups: LSTV + and LSTV-. Demographic, surgical, and radiographic data, including L4 tilt and thoracolumbar/lumbar (TL/L) Cobb angle, were obtained and analyzed. RESULTS LSTV was observed in 15 patients (24.5%). The L4 tilt was not significantly different between the two groups preoperatively (P = 0.54); however, it was significantly greater in the LSTV group postoperatively (2 weeks: LSTV + = 11.7 ± 3.1, LSTV - = 8.8 ± 3.2, P = 0.013; 2 years: LSTV + = 11.5 ± 3.5, LSTV - = 7.9 ± 4.1, P = 0.006; 5 years: LSTV + = 9.8 ± 3.1, LSTV - = 7.3 ± 4.5, P= 0.042). The postoperative TL/L curve was greater in the LSTV + group, with significant differences at 2 weeks and 2 years postoperatively (preoperative: LSTV + = 53.5 ± 11.2, LSTV - = 51.7 ± 10.3,P = 0.675; 2 weeks: LSTV + = 16.1 ± 5.0, LSTV- = 12.2 ± 6.6, P = 0.027; 2 years: LSTV + = 21.7 ± 5.9, LSTV - = 17.6 ± 5.9, P = 0.035; 5 years: LSTV + = 18.7 ± 5.8, LSTV - = 17.0 ± 6.1, P = 0.205). CONCLUSION The prevalence of LSTV in Lenke 5C AIS patients was 24.5%. Lenke 5C AIS patients with LSTV with the LIV at L3 had a significantly greater postoperative L4 tilt than those without LSTV and retained the TL/L curve.
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Affiliation(s)
- Ippei Yamauchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Ryoji Tauchi
- Department of Orthopaedic Surgery, Meijo Hospital, Nagoya, Japan
| | - Tetsuya Ohara
- Department of Orthopaedic Surgery, Meijo Hospital, Nagoya, Japan
| | - Noriaki Kawakami
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
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Meng D, Boyer E, Pujades S. Vertebrae localization, segmentation and identification using a graph optimization and an anatomic consistency cycle. Comput Med Imaging Graph 2023; 107:102235. [PMID: 37130486 DOI: 10.1016/j.compmedimag.2023.102235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/23/2023] [Accepted: 03/24/2023] [Indexed: 05/04/2023]
Abstract
Vertebrae localization, segmentation and identification in CT images is key to numerous clinical applications. While deep learning strategies have brought to this field significant improvements over recent years, transitional and pathological vertebrae are still plaguing most existing approaches as a consequence of their poor representation in training datasets. Alternatively, proposed non-learning based methods take benefit of prior knowledge to handle such particular cases. In this work we propose to combine both strategies. To this purpose we introduce an iterative cycle in which individual vertebrae are recurrently localized, segmented and identified using deep-networks, while anatomic consistency is enforced using statistical priors. In this strategy, the transitional vertebrae identification is handled by encoding their configurations in a graphical model that aggregates local deep-network predictions into an anatomically consistent final result. Our approach achieves the state-of-the-art results on the VerSe20 challenge benchmark, and outperforms all methods on transitional vertebrae as well as the generalization to the VerSe19 challenge benchmark. Furthermore, our method can detect and report inconsistent spine regions that do not satisfy the anatomic consistency priors. Our code and model are openly available for research purposes.1.
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Affiliation(s)
- Di Meng
- Inria, Univ. Grenoble Alpes, CNRS, Grenoble INP, LJK, France.
| | - Edmond Boyer
- Inria, Univ. Grenoble Alpes, CNRS, Grenoble INP, LJK, France
| | - Sergi Pujades
- Inria, Univ. Grenoble Alpes, CNRS, Grenoble INP, LJK, France
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Becker L, Adl Amini D, Ziegeler K, Muellner M, Diekhoff T, Hughes AP, Pumberger M. Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5. Arch Orthop Trauma Surg 2023; 143:1753-1759. [PMID: 34999995 PMCID: PMC10030414 DOI: 10.1007/s00402-021-04303-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/08/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. MATERIAL AND METHODS We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. RESULTS Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. CONCLUSIONS For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dominik Adl Amini
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th S, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Prevalence of Lumbosacral Transition Vertebrae in Symptomatic Adults and the Levels of Degeneration in the Suprajacent Disc. SURGERIES 2023. [DOI: 10.3390/surgeries4010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Lumbosacral transition vertebra (LSTV) is a common occurrence and its prevalence ranges from 2.6% to 35.6%. Our aim is to study this phenomenon in the adult Singaporean population and assess the level of degeneration of the suprajacent disc in those with LSTV. Retrospectively, 545 patients (Age = 57.6 ± 18.3 years; Male = 277; Female = 268) who underwent radiographic evaluation of the lumbar spine for lower back pain or radicular symptoms were shortlisted. LSTV was found to be present in 106 patients (19.4%) with sacralization of L5 and lumbarization of S1 occurring in 96 patients (17.6%) and 10 patients (1.8%), respectively. The most common form of LSTV was Castellvi type IIA (46 patients; 43.4%). Based on Pfirrmann grading, Grade IV disc degeneration was most common in both the LSTV level (63%) and the unfused suprajacent level (77%) in those with LSTV. There was a significantly higher number of patients with grade IV and above degeneration in the suprajacent disc level among those with LSTV when compared to the last unfused (L5-S1) disc level in those without LSTV (84% vs. 65%; p = 0.0001). This suprajacent disc degeneration seen in patients with LSTV may contribute to low back pain and related problems in these patients.
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Bhagchandani C, Murugan C, Jakkepally S, Shetty AP, Kanna RM, Rajasekaran S. A Whole Spine MRI Based Study of the Prevalence, Associated Disc Degeneration and Anatomical Correlations of Lumbosacral Transitional Vertebra. Global Spine J 2023:21925682231161559. [PMID: 36867110 DOI: 10.1177/21925682231161559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Lumbosacral transitional vertebra (LSTV) results in numerical alterations of the lumbar and sacral segments. Literature concerning true prevalence, associated disc degeneration, and variation in numerous anatomical landmarks concerning LSTV is lacking. METHODS This is a retrospective cohort study. The prevalence of LSTV was determined in whole spine MRIs of 2011 poly-trauma patients. LSTV was identified as sacralization (LSTV-S) or lumbarization (LSTV-L) and further sub-classified into Castellvi's and O'Driscoll's type respectively. Disc degeneration was evaluated using Pfirmann grading. Variation in important anatomical landmarks was also analysed. RESULTS Prevalence of LSTV was 11.6% with 82% having LSTV-S. Castellvi's type 2A and O'Driscoll type 4 were the commonest sub-types. LSTV patients demonstrated considerably advanced disc degeneration. The median termination level of conus medullaris (TLCM) in non- LSTV and LSTV-L groups was at middle L1 (48.1% and 40.2%) while in the LSTV-S group, it was at upper L1 (47.2%). The median level of right renal artery (RRA) in non- LSTV patients was at middle L1 in 40.0% of individuals while in the LSTV-L and LSTV-S groups, it was at upper L1 level in 35.2% and 56.2% respectively. The median level of abdominal aortic bifurcation (AA) in non-LSTV and LSTV-S patients was at middle L4 in 83.3% and 52.04% respectively. However, in the LSTV-L group, the most common level was middle L5 (53.6%). CONCLUSION The overall prevalence of LSTV was 11.6%, with sacralization accounting for more than 80%. LSTV is associated with disc degeneration and a variation in the levels of important anatomical landmarks.
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Affiliation(s)
| | - Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
| | - Sridhar Jakkepally
- Department of Spine Surgery, Gandhi Medical College and Hospital, Secunderabad, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
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Shen SC, Chen HC, Tsou HK, Lin RH, Shih YT, Huang CW, Tang CL, Chen HT, Chang CC, Tzeng CY. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation based on image analysis and clinical findings: A retrospective review of 345 cases. Medicine (Baltimore) 2023; 102:e32832. [PMID: 36749265 PMCID: PMC9901959 DOI: 10.1097/md.0000000000032832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective review aims to assess the safety and effectiveness of PELD for treating L5-S1 disc herniation with a range of characteristics and to determine the prevalence of lumbosacral transitional vertebrae (LSTV) anatomical anomalies to facilitate pre-surgical planning. From July 2005 to June 2019, 345 patients with L5-S1 disc herniations were treated with PELD. The primary outcome was 1-year postoperative visual analogue scale scores for low back and lower limb pain. The secondary outcomes included the surgical approach used, lumbosacral bony anomalies, presence of a ruptured disc or severely calcified disc, pediatric lumbar disc herniation, recurrent disc herniation management, and the long-term outcome. visual analogue scale scores for most patients were significantly improved after surgery. The prevalence of LSTVs was 4.05% (14/345 patients) in lumbar sacralization and 7.53% (26/345 patients) in sacral lumbarization. The prevalence of ruptured and severely calcified discs was 18.55% (64/345) and 5.79% (20/345), respectively. The prevalence of pediatric lumbar disc herniation was 2.02% (7/345). The recurrence rate was 4.34% (15/345). Two durotomy cases without sequelae and 8 cases of lower limb dysesthesia lasting longer than 3 months postoperatively were reported. PELD is safe and effective for treating L5-S1 disc herniation, including cases complicated by calcified lumbar disc herniation, disc rupture with migration, and the presence of LSTV. Appropriate imaging is essential to identify case-specific factors, including the prevalent LSTV anatomical anomalies, before surgery.
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Affiliation(s)
- Shih-Chieh Shen
- Department of Surgery, Tri-Service General Hospital Songshan Branch, National, Defense Medical Center, Taiwan, R.O.C
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taiwan, R.O.C
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, R.O.C
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, R.O.C
- * Correspondence: Hsi-Kai Tsou, Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung, Taiwan 40705, R.O.C (e-mail: )
| | - Ruei-Hong Lin
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Yu-Tung Shih
- Department of Neurosurgery, Jen-Ai Hospital, Taichung, Taiwan, R.O.C
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, R.O.C
| | - Chih-Wei Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Chien-Lun Tang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Hsien-Te Chen
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan, R.O.C
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
- Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
- Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County, Taiwan, R.O.C
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Verhaegen JC, Alves Batista N, Horton I, Rakhra K, Beaulé PE, Michielsen J, Stratton A, Grammatopoulos G. Prevalence of Lumbosacral Transitional Vertebral Anomalies Among Healthy Volunteers and Patients with Hip Pathology: Association with Spinopelvic Characteristics. JB JS Open Access 2023; 8:e22.00095. [PMID: 37908325 PMCID: PMC10614646 DOI: 10.2106/jbjs.oa.22.00095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
A lumbosacral transitional vertebra (LSTV) has been reported to be prevalent among patients with hip dysplasia. The aims of this study were to determine the (1) prevalence of an LSTV in young patients presenting with hip pain and a group of asymptomatic volunteers, (2) effect of an LSTV on spinopelvic characteristics, and (3) presence of low back pain among patients with an LSTV. Methods This cross-sectional study included 102 patients with hip pathology and 51 asymptomatic volunteers (mean age, 33.9 ± 7.3 years; mean body mass index, 26.0 ± 5.0 kg/m2; 57.5% female). Participants underwent radiographic assessment of the lumbar spine and pelvis in standing and deep-seated positions. LSTV occurrence was classified according to the Castellvi system. Spinopelvic characteristics included lumbar lordosis (including segmental lumbar angles), pelvic tilt, and hip flexion (pelvic-femoral angle). Differences between standing and deep-seated values were calculated. Low back pain was assessed using the Oswestry Disability Index. Results The prevalence of LSTV type ≥II was 8.5%, with no difference between patients and volunteers (p = 0.386). Individuals with an LSTV had a greater standing L1-L5 angle (mean, 51.6° ± 11.7° versus 38.9° ± 9.3°; p < 0.001). The overall spinal flexion (change in L1-S1 angle between the standing and deep-seated positions) in individuals with an LSTV was similar to that in individuals without an LSTV; restricted L5-S1 mobility was compensated for at L1-L2 (10.2° ± 5.8° in those with versus 8.4° ± 4.1° in those without an LSTV; p = 0.070). No significant difference in the presence of low back pain was found (p = 0.250). Conclusions An LSTV was found in 8.5% of young adults, with no difference between patients with hip pathology and controls. Individuals with an LSTV have greater standing lumbar lordosis, with altered mechanics at the cephalad adjacent level, which may predispose these individuals to degenerative changes at this level. Level of Evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeroen C.F. Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- University Hospital Antwerp, Edegem, Belgium
| | - Nuno Alves Batista
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabel Horton
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kawan Rakhra
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E. Beaulé
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Alexandra Stratton
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Abul K, Özmen BB, Yücekul A, Zulemyan T, Yılgör Ç, Alanay A. If you look this way, you will see it: cranial shift in adolescent idiopathic scoliosis. Spine Deform 2023; 11:105-114. [PMID: 35921040 DOI: 10.1007/s43390-022-00560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Anatomical variations in the spine can be seen in each transitional border, either toward the skull as 'cranial shifts' or away as caudal shifts. Cranial shifting (CS) occurs when there is presence of occipitalization, C7 cervical costae or prominent transverse processes, thoracolumbar transitional vertebrae (TLTV) at T12 level, L5 sacralization, and sacrococcygeal fusion. We termed the coexistence of sacralization of L5 and absence or remarkable reduction of T12 rib size in AIS as Abul cranial shift (ACS). In this descriptive clinical study, primary aim was to investigate the incidence of ACS in AIS. METHODS Retrospective analysis of 187 surgically treated AIS cases was performed. Demographic data were recorded. The incidence of the specific set of anatomic variations including lumbosacral transitional vertebrae, TLTV, transverse process changes in C7 vertebrae, and posterior lumbosacral neural arch cleft formations (NACf) were evaluated in the radiological images. RESULTS 36 (19%) of 187 cases had ACS. ACS was detected in only 1 of 19 male cases (5%), while in 35 of 168 female cases (21%). Forty-one cases had sacralization of L5 (22%). There were only eleven pair of ribs in 14 (7%) of 187 cases and 10 (28%) of 36 ACS cases. Forty cases had NACf (21%). ACS and NACf coexistence were observed in 8 (22%) of 36 ACS cases. CONCLUSION Accurate spinal column assessment is critical in adolescent idiopathic scoliosis (AIS). ACS may be observed in up to one in five AIS cases and its presence should not be neglected to avoid wrong level surgery.
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Affiliation(s)
- Kadir Abul
- Department of Orthopedics and Traumatology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey.
| | - Berk Barış Özmen
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altuğ Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Çağlar Yılgör
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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24
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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Aliyev MA, Hozeev DV, Biryuchkov MY, Kundubayev RA, Riew KD. Prevalence of lumbosacral transitional vertebra among 4816 consecutive patients with low back pain: A computed tomography, magnetic resonance imaging, and plain radiographic study with novel classification schema. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:35-43. [PMID: 37213577 PMCID: PMC10198219 DOI: 10.4103/jcvjs.jcvjs_149_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/15/2023] [Indexed: 03/18/2023] Open
Abstract
Study Design A retrospective single-center study. Background The prevalence of the lumbosacral anomalies remains controversial. The existing classification to characterize these anomalies is more complex than necessary for clinical use. Purpose To assessment of the prevalence of lumbosacral transitional vertebra (LSTV) in patients with low back pain and the development of clinically relevant classification to describe these anomalies. Materials and Methods During the period from 2007 to 2017, all cases of LSTV were preoperatively verified, and classified according to Castellvi, as well as O'Driscoll. We then developed modifications of those classifications that are simpler, easier to remember, and clinically relevant. At the surgical level, this was assessed intervertebral disc and facet joint degeneration. Results The prevalence of the LSTV was 8.1% (389/4816). The most common L5 transverse process anomaly type was fused, unilaterally or bilaterally (48%), to the sacrum and were O'Driscoll's III (40.1%) and IV (35.8%). The most common type of S1-2 disc was a lumbarized disc (75.9%), where the disc's anterior-posterior diameter was equal to the L5-S1 disc diameter. In most cases, neurological compression symptoms (85.5%) were verified to be due to spinal stenosis (41.5%) or herniated disc (39.5%). In the majority of patients without neural compression, the clinical symptoms were due to mechanical back pain (58.8%). Conclusions LSTV is a fairly common pathology of the lumbosacral junction, occurring in 8.1% of the patients in our series (389 out of 4,816 cases). The most common types were Castellvi's type IIA (30.9%) and IIIA (34.9%) and were O'Driscoll's III (40.1%) and IV (35.8%).
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Affiliation(s)
- Vadim A. Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Andrei A. Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Valery V. Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | | | - Marat A. Aliyev
- Department of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Dmitriy V. Hozeev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Mikhail Y. Biryuchkov
- Department of Neurosurgery with Traumatology Course, West Kazakhstan Marat Ospanov Medical Unversity, Aktobe, Kazakhstan
| | - Rustem A. Kundubayev
- Department of Neurosurgery with Traumatology Course, West Kazakhstan Marat Ospanov Medical Unversity, Aktobe, Kazakhstan
| | - K. Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York City, New York, USA
- Department of Neurological Surgery, Weill Cornell Medical School, New York City, New York, USA
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25
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Morbée L, Vereecke E, Laloo F, Chen M, Herregods N, Jans LBO. Common incidental findings on sacroiliac joint MRI: Added value of MRI-based synthetic CT. Eur J Radiol 2023; 158:110651. [PMID: 36535080 DOI: 10.1016/j.ejrad.2022.110651] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the prevalence of incidental findings on sacroiliac joint MRI and to determine the added value of MRI-based synthetic CT in the detection and evaluation of these incidental findings. METHOD In this retrospective study 210 patients clinically suspected of spondyloarthritis who underwent MRI of the sacroiliac joint with synthetic CT sequence were included. The images were reviewed by two radiologists in consensus for the prevalence of sacroiliitis, incidental findings, and the ability of synthetic CT and the conventional MRI to detect and diagnose these findings. RESULTS In 44.7% of patients sacroiliitis was present. In 89.0% of patients MRI showed at least one incidental finding other than sacroiliitis. Degeneration of the sacroiliac joint was the most prevalent finding (140 patients, 66.6%). The most frequent incidental findings outside the sacroiliac joint were facet joint degeneration (29.0%), disc degeneration (25.2%), enostosis (19.5%) and lumbosacral transitional vertebrae (14.3%). A total of 788 lesions was recorded and synthetic CT was found to be problem solving or necessary for diagnosis in 543 (68.9%) of these lesions. 42.1% of lesions were not visible on conventional MRI (T1 TSE and STIR), most often degenerative osteophytes in the sacroiliac joint or lower lumbar spine. CONCLUSION Incidental findings are seen more frequently on sacroiliac joint MRI than sacroiliitis, which is relevant as some will have clinical significance or require treatment. Nearly half of these incidental lesions were only visible on synthetic CT, which additionally has been shown to be problem solving for diagnosis in many other cases.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Min Chen
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lennart B O Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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26
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Plessis AMD, Wessels Q, Schoor AV, Keough N. Congenital malformations in the vertebral column: associations and possible embryologic origins. Anat Cell Biol 2022; 55:399-405. [PMID: 36071544 PMCID: PMC9747346 DOI: 10.5115/acb.22.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 01/02/2023] Open
Abstract
Cases of associations between random spinal congenital defects have previously been reported, yet several questions remain unanswered. Firstly, why are associations between what seems to be random combinations of vertebral malformations observed? Secondly, is there a common event or pattern that connects the associated defects? Therefore, this study aimed to identify congenital defects in the vertebral column and also to determine whether any associations, if present, between vertebral malformations exist. This article consequently discusses the possible embryological disruptions that may lead to the formation of various defects in the vertebral column. A random skeletal sample (n=187) was selected from the Pretoria Bone Collection housed in the Department of Anatomy, University of Pretoria (Ethics 678/2018). The sample was evaluated to determine the frequencies of spinal congenital defects in each set of remains. Identifiable congenital malformations were observed in 48.1% (n=90/187) of the sample. The results demonstrated a high probability of association between the different defects observed in the vertebral column. Findings are of value as they provide a reasonable explanation to why seemingly random cases of associations have been reported by several authors. This study is clinically relevant as severe spinal defects have been shown to have high morbidity in patients and mortality in infants.
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Affiliation(s)
- Anneli M. Du Plessis
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa,Department Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia,Corresponding author: Anneli M. Du Plessis, Department of Anatomy, School of Medicine, University of Namibia, Windhoek 9000, Namibia, E-mail: /
| | - Quenton Wessels
- Department Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Albert Van Schoor
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa
| | - Natalie Keough
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa,Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
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27
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Vinha A, Bártolo J, Lemos C, Cordeiro F, Rodrigues-Pinto R. Lumbosacral transitional vertebrae: prevalence in a southern European population and its association with low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3647-3653. [PMID: 36208322 DOI: 10.1007/s00586-022-07415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/16/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Lumbosacral transitional vertebra (LSTV) is a congenital anomaly of the lumbosacral junction. Its prevalence is variable in the literature such as its association with low back pain. The aim of this study was to identify the prevalence of LSTV in a southern European population, and its correlation with low back pain. METHODS A retrospective review of 639 thoraco-abdomino-pelvic consecutive CT-scans between January 2019 and November 2020 was performed. The presence of LSTV was classified into type II, III, IV based on Castellvi's classification. To investigate the association with low back pain, Oswestry Low Back Disability Questionnaire (ODI) and the EuroQol-5D-3L questionnaire was applied. RESULTS The prevalence of LSTV was 24.9% (142 of 571). 37,3% were type IIb, 31,0% were type IIa, 13,4% were type IIIa, 9.9% were type IIIb and 8.5% were type IV. Individuals with LSTV were more likely to report low back pain and have a higher ODI score (OR:0.392, 95% CI:0.192-0.802, p = 0.010), (OR: 1050, 95% CI: 1029-1072, p < 0.01). Castellvi's type IV showed a significantly higher ODI when compared to type II (OR:1059, 95% CI:1019-1100, p = 0,04). There was no statistical difference in the EuroQol-5D-3L score between two groups (OR:1085, 95% CI: 0.459-2.560, p = 0.852). CONCLUSION This population-based study adds to the literature the prevalence of LSTV in a southern European population. LSTV was associated with low back pain. However, this difference did not translate into a loss of quality life. Type IV was associated with higher functional disability when compared with type II.
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Affiliation(s)
- André Vinha
- Spine Unit, Porto University Hospital Centre, Porto, Portugal. .,Centro Hospitalar Universitário Do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - João Bártolo
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Carolina Lemos
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Filipa Cordeiro
- Spine Unit, Porto University Hospital Centre, Porto, Portugal
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28
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An CH, Lee JS, Jang JS, Choi HC. Part Affinity Fields and CoordConv for Detecting Landmarks of Lumbar Vertebrae and Sacrum in X-ray Images. SENSORS (BASEL, SWITZERLAND) 2022; 22:8628. [PMID: 36433225 PMCID: PMC9696411 DOI: 10.3390/s22228628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
With the prevalence of degenerative diseases due to the increase in the aging population, we have encountered many spine-related disorders. Since the spine is a crucial part of the body, fast and accurate diagnosis is critically important. Generally, clinicians use X-ray images to diagnose the spine, but X-ray images are commonly occluded by the shadows of some bones, making it hard to identify the whole spine. Therefore, recently, various deep-learning-based spinal X-ray image analysis approaches have been proposed to help diagnose the spine. However, these approaches did not consider the characteristics of frequent occlusion in the X-ray image and the properties of the vertebra shape. Therefore, based on the X-ray image properties and vertebra shape, we present a novel landmark detection network specialized in lumbar X-ray images. The proposed network consists of two stages: The first step detects the centers of the lumbar vertebrae and the upper end plate of the first sacral vertebra (S1), and the second step detects the four corner points of each lumbar vertebra and two corner points of S1 from the image obtained in the first step. We used random spine cutout augmentation in the first step to robustify the network against the commonly obscured X-ray images. Furthermore, in the second step, we used CoordConv to make the network recognize the location distribution of landmarks and part affinity fields to understand the morphological features of the vertebrae, resulting in more accurate landmark detection. The proposed network was evaluated using 304 X-ray images, and it achieved 98.02% accuracy in center detection and 8.34% relative distance error in corner detection. This indicates that our network can detect spinal landmarks reliably enough to support radiologists in analyzing the lumbar X-ray images.
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Affiliation(s)
- Chang-Hyeon An
- Intelligent Computer Vision Software Laboratory (ICVSLab), Department of Electronic Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Gyeongbuk, Korea
| | - Jeong-Sik Lee
- Intelligent Computer Vision Software Laboratory (ICVSLab), Department of Electronic Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Gyeongbuk, Korea
| | - Jun-Su Jang
- Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, South Chungcheong, Korea
| | - Hyun-Chul Choi
- Intelligent Computer Vision Software Laboratory (ICVSLab), Department of Electronic Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Gyeongbuk, Korea
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29
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Aslam S, Aslam I, Tsang J, Latief F, Thatuskar A, Rojed N. Accessory articulation of cervical vertebral transverse process: a rare case. BJR Case Rep 2022; 8:20210119. [PMID: 36632549 PMCID: PMC9809920 DOI: 10.1259/bjrcr.20210119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 01/14/2023] Open
Abstract
There are several anatomical variants of the cervical vertebrae described in literature ranging from benign findings to those with varying clinical implications, including association with congenital diseases. We describe a case of an extremely rare anatomical variant of the cervical spine consisting of an accessory articulation of the cervical vertebrae C4 and C5 right transverse processes. The case is of a 35-year-old female who presented to primary care with 6-week history of intermittent, dull neck pain. An X-ray of the cervical spine was obtained which did not demonstrate radiological evidence of an acute fracture, dislocation, nor vertebral collapse. However, the X-ray revealed subtle multilevel anterior marginal osteophytic lipping. As a minor fragmented fracture or osteophytic growth could not be excluded; the patient proceeded to have a CT of the cervical spine. This revealed an accessory articulation of both the C4 and C5 right transverse processes, an extremely rare anatomical variant. Our comparison of both X-ray and CT imaging modality results highlighted the importance of utilising CT in identification in the accessory articulation anomaly, which aids in directing patient to appropriate care. Although similar cases may have been seen in clinical practice, to our knowledge, there are no previously documented C4-5 accessory articulations in the literature.
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Affiliation(s)
- Sarmad Aslam
- Department of Radiology, Lincoln County Hospital, Lincoln, UK
| | - Iqrah Aslam
- King’s College London School of Medicine, London, UK
| | - Jeffrey Tsang
- Department of Radiology, Lincoln County Hospital, Lincoln, UK
| | - Farris Latief
- Department of Medicine, Grantham & District Hospital, England, UK
| | | | - Naveen Rojed
- Department of Radiology, Lincoln County Hospital, Lincoln, UK
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30
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Fidan F, Çay N, Asiltürk M, Veizi E. The incidence of congenital lumbosacral malformations in young male Turkish military school candidates population. J Orthop Sci 2022; 27:1167-1171. [PMID: 34391615 DOI: 10.1016/j.jos.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/12/2021] [Accepted: 07/06/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND During routine radiological examinations of the lumbar spine, congenital anomalies such as lumbosacral transition vertebra and scoliosis are frequently encountered in asymptomatic patients. They are not always associated with pathologies but have the potential to cause back pain in later times. The aim of this study is to analyze the prevalence of lumbar vertebral abnormalities in a group of young military school candidates who had no prior complaints. METHODS We retrospectively evaluated the direct radiographs of asymptomatic young men aged between 17 and 22 applying between July 2018 and August 2018, for the routine check-up before becoming military school students. Exclusion criteria were prior history of low back pain for any reason, sciatica, neurogenic claudication, history of prior spinal surgery and history of a concomitant rheumatologic disease. All radiographs were evaluated for total lumbar vertebra number, morphology, presence of lumbosacral transitional vertebrae (LSTV), spina bifida occulta (SBO) and presence of lumbar and/or lumbar-elongated scoliosis. RESULTS All 3132 patients were male and mean age was 18.37. Out of them, 887 (28.3%) had a congenital lumbo-sacral anomaly that they were not aware of. The most common anomaly we detected was SBO, in 16.2% of the cases followed by LSTV with 12.9% of the cases. Some of the applicants had more than one anomaly in their X-rays. CONCLUSION Correct identification of a lumbar abnormalities is of great importance, especially before surgical procedures. It is a known fact that most wrong-level spine surgery occurs in patients with variant spine anatomy, including LSTV. Meticulous screening and analyses should be performed to all patients scheduled for spinal surgery in order to avoid peri-operative complications and unwanted final results.
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Affiliation(s)
- Fatma Fidan
- Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey
| | - Nurdan Çay
- Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Radiology, Ankara, Turkey
| | - Mehmet Asiltürk
- Ankara City Hospital, Department of Orthopedics and Traumatology, 06000, Ankara, Turkey
| | - Enejd Veizi
- Ankara City Hospital, Department of Orthopedics and Traumatology, 06000, Ankara, Turkey.
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Becker L, Schönnagel L, Mihalache TV, Haffer H, Schömig F, Schmidt H, Pumberger M. Lumbosacral transitional vertebrae alter the distribution of lumbar mobility–Preliminary results of a radiographic evaluation. PLoS One 2022; 17:e0274581. [PMID: 36174065 PMCID: PMC9521836 DOI: 10.1371/journal.pone.0274581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background Lumbo-sacral transitional vertebrae (LSTV) are one of the most common congenital variances of the spine. They are associated with an increased frequency of degeneration in the cranial adjacent segment. Hypermobility and concomitant increased loads are discussed as a possible reason for segmental degeneration. We therefore examined the lumbar and segmental motion distribution in patients with LSTV with flexion-extension radiographs. Methods A retrospective study of 51 patients with osteochondrosis L5/S1 with flexion and extension radiographs was performed. Of these, 17 patients had LSTV and were matched 1:1 for age and sex with patients without LSTV out of the collective of the remaining 34 patients. The lumbar and segmental range of motion (RoM) by segmental lordosis angle and the segmental wedge angle were determined. Normal distribution of parameters was observed by Kolmogorov-Smirnov-test. Parametric data were compared by paired T-test. Non-parametric data were compared by Wilcoxon-rank-sum-test. Correlations were observed using Spearman’s Rank correlation coefficient. A p-value <0.05 was stated as statistically significant. Results Patients with LSTV had mean age of 52.2±10.9, control group of 48.9±10.3. Both groups included 7 females and 10 males. Patients with LSTV presented with reduced RoM of the lumbar spine (LSTV 37.3°±19.2°, control 52.1°±20.5°, p = 0.065), however effects were statistically insignificant. LSTV significantly decreased segmental RoM in the transitional segment (LSTV 1.8°±2.7°, control 6.7°±6.0°, p = 0.003). Lumbar motion distribution differed significantly; while RoM was decreased in the transitional segment, (LSTV 5.7%, control 16.2%, p = 0.002), the distribution of lumbar motion to the cranial adjacent segment was increased (LSTV 30.7%, control 21.6%, p = 0.007). Conclusion Patients with LSTV show a reduced RoM in the transitional segment and a significantly increased motion distribution to the cranial adjacent segment in flexion-extension radiographs. The increased proportion of mobility in the cranial adjacent segment possibly explain the higher rates of degeneration within the segment.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité –University Medicine, Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité –University Medicine, Berlin, Germany
- * E-mail:
| | - Lukas Schönnagel
- Center for Musculoskeletal Surgery, Charité –University Medicine, Berlin, Germany
| | - Tim Victor Mihalache
- Center for Musculoskeletal Surgery, Charité –University Medicine, Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité –University Medicine, Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité –University Medicine, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité –University Medicine, Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité –University Medicine, Berlin, Germany
| | - Hendrik Schmidt
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité –University Medicine, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité –University Medicine, Berlin, Germany
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Becker L, Taheri N, Haffer H, Muellner M, Hipfl C, Ziegeler K, Diekhoff T, Pumberger M. Lumbosacral Transitional Vertebrae Influence on Acetabular Orientation and Pelvic Tilt. J Clin Med 2022; 11:jcm11175153. [PMID: 36079079 PMCID: PMC9457479 DOI: 10.3390/jcm11175153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Lumbosacral transitional vertebrae (LSTV) are common congenital variances with a prevalence found in the population up to 35.6%. The literature demonstrates an influence of LSTV on bony pelvic anatomy. The influence on the anatomical acetabular orientation, which is important for cup positioning in total hip arthroplasty, has not yet been described for patients with LSTV. A total of 53 patients with LSTV were identified from a CT Database including 819 subjects. Fifty patients with LSTV could be included and were matched for age and sex against a control group. We examined the influence of LSTV, classified according to Castellvi, on acetabular orientation and pelvic tilt in the supine position. Functional acetabular anteversion and inclination, assessed against the table plane, were compared against anatomical acetabular anteversion and inclination, assessed against the anterior pelvic plane. The anatomical acetabular inclination correlated with the pelvic tilt (r = 0.363, p < 0.001). The anatomical acetabular inclination was significantly larger than the functional acetabular inclination in the supine position (p < 0.001). Castellvi grading of LSTV correlated negatively with pelvic tilt (ρ = −0.387, p = 0.006). Castellvi grading correlated significantly with functional acetabular anteversion (ρ = 0.324, p = 0.022) and anatomical acetabular anteversion (ρ = 0.306, p = 0.022). A higher Castellvi grading was accompanied by a reduced pelvic tilt in the supine position. The functional acetabular anteversion and anatomical acetabular anteversion increased in parallel to the higher Castellvi grading. Therefore, LSTV and Castellvi grading might be assessed on pre-operative X-rays prior to hip arthroplasty and surgeons might consider adjusting cup positioning accordingly.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité—University Medicine, Augustenburger Pl. 1, 13353 Berlin, Germany
- Correspondence:
| | - Nima Taheri
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department for Radiology, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department for Radiology, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
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Hipp JA, Grieco TF, Newman P, Reitman CA. Definition of normal vertebral morphometry using NHANES‐II radiographs. JBMR Plus 2022; 6:e10677. [PMID: 36248278 PMCID: PMC9549721 DOI: 10.1002/jbm4.10677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
A robust definition of normal vertebral morphometry is required to confidently identify abnormalities such as fractures. The Second National Health and Nutrition Examination Survey (NHANES‐II) collected a nationwide probability sample to document the health status of the United States. Over 10,000 lateral cervical spine and 7,000 lateral lumbar spine X‐rays were collected. Demographic, anthropometric, health, and medical history data were also collected. The coordinates of the vertebral body corners were obtained for each lumbar and cervical vertebra using previously validated, automated technology consisting of a pipeline of neural networks and coded logic. These landmarks were used to calculate six vertebral body morphometry metrics. Descriptive statistics were generated and used to identify and trim outliers from the data. Descriptive statistics were tabulated using the trimmed data for use in quantifying deviation from average for each metric. The dependency of these metrics on sex, age, race, nation of origin, height, weight, and body mass index (BMI) was also assessed. There was low variation in vertebral morphometry after accounting for vertebrae (eg, L1, L2), and the R2 was high for ANOVAs. Excluding outliers, age, sex, race, nation of origin, height, weight, and BMI were statistically significant for most of the variables, though the F‐statistic was very small compared to that for vertebral level. Excluding all variables except vertebra changed the ANOVA R2 very little. Reference data were generated that could be used to produce standardized metrics in units of SD from mean. This allows for easy identification of abnormalities resulting from vertebral fractures, atypical vertebral body morphometries, and other congenital or degenerative conditions. Standardized metrics also remove the effect of vertebral level, facilitating easy interpretation and enabling data for all vertebrae to be pooled in research studies. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- John A. Hipp
- Medical Metrics, Imaging Core Laboratory Houston TX
| | | | | | - Charles A. Reitman
- Orthopaedics and Physical Medicine Medical University of South Carolina Charleston SC
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Hagihara S, Nakagawa M, Matsubara K, Godai K, Kamijima K, Abe Y. Successful annuloplasty using the cone-beam computed tomography-assisted radiofrequency thermocoagulation system in a patient with severe vertebral deformity: a case report. JA Clin Rep 2022; 8:63. [PMID: 35962238 PMCID: PMC9374857 DOI: 10.1186/s40981-022-00554-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Complex anatomical features are challenging for minimally invasive intradiscal therapy owing to insufficient visualization for accurate needle advancement. We report the case of a patient with dysraphic vertebral pathologies who presented with L5/S1 degeneration and was successfully treated with annuloplasty using the cone-beam computed tomography (CBCT)-assisted radiofrequency thermocoagulation system. Case presentation A 34-year-old woman presented with a lower back and left radicular pain of L5/S1 discogenic origin, accompanied by spina bifida occulta and lumbosacral transitional vertebra. Radiofrequency annuloplasty was performed to preserve disc height and spinal stability, with real-time CBCT guidance for the congenital and degenerative conditions. The procedure relieved her left lower-extremity pain and magnetic resonance imaging revealed that the L5/S1 disc bulging decreased while the disc height was preserved. Conclusion Optimal accessibility of radiofrequency thermocoagulation and effective needle guidance using CBCT significantly improve the success rate of annuloplasty at the L5/S1 degenerative disc with severe vertebral deformity.
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Vereecke E, Herregods N, Morbée L, Laloo F, Chen M, Jans L. Imaging of Structural Abnormalities of the Sacrum: The Old Faithful and Newly Emerging Techniques. Semin Musculoskelet Radiol 2022; 26:469-477. [PMID: 36103888 DOI: 10.1055/s-0042-1754342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The sacrum and sacroiliac joints pose a long-standing challenge for adequate imaging because of their complex anatomical form, oblique orientation, and posterior location in the pelvis, making them subject to superimposition. The sacrum and sacroiliac joints are composed of multiple diverse tissues, further complicating their imaging. Varying imaging techniques are suited to evaluate the sacrum, each with its specific clinical indications, benefits, and drawbacks. New techniques continue to be developed and validated, such as dual-energy computed tomography (CT) and new magnetic resonance imaging (MRI) sequences, for example susceptibility-weighted imaging. Ongoing development of artificial intelligence, such as algorithms allowing reconstruction of MRI-based synthetic CT images, promises even more clinical imaging options.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
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Barkhane Z, Belaaroussi S, Foudail M. Bilateral Bertolotti's Syndrome: A Case Report of an Uncommon Presentation of Chronic Low Back Pain in an Elder Patient. Cureus 2022; 14:e26569. [PMID: 35936116 PMCID: PMC9351821 DOI: 10.7759/cureus.26569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 12/05/2022] Open
Abstract
Lower back pain caused by anatomical lumbosacral transitional vertebra is known as Bertolotti's syndrome. We present the case of a 65-year-old male with persistent chronic lower back pain with radiological evidence of an anatomical lumbosacral pseudo-joint bilaterally. The patient underwent conservative treatment with lidocaine and steroids that helped to improve and manage his symptoms. Our patient is an elderly one, and it is quite uncommon for the first appearance of Bertolotti's syndrome. Therefore, Bertolotti's syndrome is a rare cause of lower back pain, and clinicians should consider it in the differential diagnosis.
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Okamoto M, Hasegawa K, Hatsushikano S, Kobayashi K, Sakamoto M, Ohashi M, Watanabe K. Influence of lumbosacral transitional vertebrae on spinopelvic parameters using biplanar slot scanning full body stereoradiography-analysis of 291 healthy volunteers. J Orthop Sci 2022; 27:751-759. [PMID: 33966957 DOI: 10.1016/j.jos.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Proper identification of lumbosacral transitional vertebrae (LSTV) is important to characterize the relationship between the transitional segment and adjacent levels. Classical classification schemes are inaccurate with respect to the whole spine. We propose a precise vertebral numbering method and investigated the relationship between LSTV and whole-body sagittal alignment. METHODS A total of 291 healthy adult volunteers with no history of spinal disease were evaluated with biplanar slot scanning full body stereoradiography to determine the prevalence of LSTV. Vertebrae were counted from the first cervical vertebra using both coronal and sagittal plane images. We then investigated the influence of LSTV on whole-body sagittal alignment in 279 participants. Whole-body key parameters descriptive statistics were compared among groups according to the number of vertebrae (L4, L5, and L6). Statistical analysis was performed between normal and LSTV cases using the Steel-Dwass analysis. RESULTS Of the 291 subjects, 14 (4.8%) had 23 vertebrae and 16 (5.5%) had 25 vertebrae. Eleven (3.8%) had Th11, 3 (1.0%) had L4, and 1 (0.3%) had Th11 + L6, 16 (5.5%) had L6. Compared with the normal group, the sacral base in relation to the pelvis was higher in the L4 group and lower in the L6 group. The C2-C7 angle and lumbar lordosis (LL) were increased in both the L4 and L6 groups. All remaining parameters were decreased in the L4 group and increased in the L6 group. The relationship between LL and PI was similar in the normal and LSTV groups, despite the difference in the sacral base location. CONCLUSIONS We propose a precise method for numbering the vertebrae using coronal and sagittal full body images. The spinopelvic parameters of the LSTV population significantly differed from those in the normal spine population due to differences in the sacral base location.
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Affiliation(s)
- Masashi Okamoto
- Niigata Spine Surgery Center, Japan; Dept. of Radiological Technology, School of Health Science, Niigata University, Japan.
| | | | - Shun Hatsushikano
- Niigata Spine Surgery Center, Japan; Dept. of Radiological Technology, School of Health Science, Niigata University, Japan
| | - Koichi Kobayashi
- Dept. of Radiological Technology, School of Health Science, Niigata University, Japan
| | - Makoto Sakamoto
- Dept. of Radiological Technology, School of Health Science, Niigata University, Japan
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Ashour A, Hassan A, Aly M, Nafady MAM. Prevalence of Bertolotti’s Syndrome in Lumbosacral Surgery Procedures. Cureus 2022; 14:e26341. [PMID: 35903576 PMCID: PMC9318490 DOI: 10.7759/cureus.26341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/05/2022] Open
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Du Plessis A, Van Schoor A, Wessels Q, Murphy P, Van Schouwenburg F, Ihuhua P, Kehrmann J, Scholtz M, Keough N. Vertebrae at the thoracolumbar junction: A quantitative assessment using CT scans. J Anat 2022; 240:1179-1186. [PMID: 34958488 PMCID: PMC9119610 DOI: 10.1111/joa.13619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
The thoracolumbar junction is often associated with traumatic injuries, due to its biomechanical instability. Reasons for this instability are currently still under debate; however, contributing factors such as the rapid change in spinal curvature and facet orientation from the thoracic to lumbar transition have been implicated. Normally, the superior facet orientation in the thoracic region is angled in a coronal plane, whereas vertebrae in the lumbar region have facets angled in the sagittal plane. Distinguishing between thoracic, lumbar, and transitional vertebrae at the thoracolumbar junction based on articular facet angles, using quantitative methods on CT scans has, to the authors' knowledge, not yet been reported in the literature. Therefore, this study aimed to evaluate whether quantitative measurements can be clinically applied and used to differentiate vertebrae at the thoracolumbar junction using CT scans and, additionally, to record possible cases of congenital defects or variations observed in the spine. A sample (n = 173) of CT scans representative of the Windhoek population in Namibia was retrospectively assessed using radio-imaging software. Measurements of the angle formed by the superior facets of the vertebrae at the thoracolumbar junction (T11-L1) were recorded. Based on the results of this study, quantitative morphometry of the superior facet of vertebrae can differentiate between thoracic, lumbar,. and transitional vertebrae at the thoracolumbar junction. All individuals with identified thoracolumbar transitional vertebrae (TLTV) in this sample had at least one other congenital anomaly of the spine.
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Affiliation(s)
- Anneli Du Plessis
- Department of AnatomyHealth Science CampusUniversity of PretoriaPretoriaSouth Africa
- Department AnatomySchool of MedicineUniversity of NamibiaWindhoekNamibia
| | - Albert Van Schoor
- Department of AnatomyHealth Science CampusUniversity of PretoriaPretoriaSouth Africa
| | - Quenton Wessels
- Department AnatomySchool of MedicineUniversity of NamibiaWindhoekNamibia
| | - Patrick Murphy
- Namibia Radiology PracticeLady Pohamba Private HospitalWindhoekNamibia
| | | | - Pulenge Ihuhua
- Namibia Radiology PracticeLady Pohamba Private HospitalWindhoekNamibia
| | - Jana Kehrmann
- Namibia Radiology PracticeLady Pohamba Private HospitalWindhoekNamibia
| | - Magda Scholtz
- Namibia Radiology PracticeLady Pohamba Private HospitalWindhoekNamibia
| | - Natalie Keough
- Department of AnatomyHealth Science CampusUniversity of PretoriaPretoriaSouth Africa
- Department of Anatomy and Cellular BiologyCollege of Medicine and Health SciencesKhalifa UniversityAbu DhabiUnited Arab Emirates
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Strong MJ, Santarosa J, Sullivan TP, Kazemi N, Joseph JR, Kashlan ON, Oppenlander ME, Szerlip NJ, Park P, Elswick CM. Pre- and intraoperative thoracic spine localization techniques: a systematic review. J Neurosurg Spine 2022; 36:792-799. [PMID: 34798613 PMCID: PMC10193475 DOI: 10.3171/2021.8.spine21480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the era of modern medicine with an armamentarium full of state-of-the art technologies at our disposal, the incidence of wrong-level spinal surgery remains problematic. In particular, the thoracic spine presents a challenge for accurate localization due partly to body habitus, anatomical variations, and radiographic artifact from the ribs and scapula. The present review aims to assess and describe thoracic spine localization techniques. METHODS The authors performed a literature search using the PubMed database from 1990 to 2020, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 27 articles were included in this qualitative review. RESULTS A number of pre- and intraoperative strategies have been devised and employed to facilitate correct-level localization. Some of the more well-described approaches include fiducial metallic markers (screw or gold), metallic coils, polymethylmethacrylate, methylene blue, marking wire, use of intraoperative neuronavigation, intraoperative localization techniques (including using a needle, temperature probe, fluoroscopy, MRI, and ultrasonography), and skin marking. CONCLUSIONS While a number of techniques exist to accurately localize lesions in the thoracic spine, each has its advantages and disadvantages. Ultimately, the localization technique deployed by the spine surgeon will be patient-specific but often based on surgeon preference.
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Affiliation(s)
- Michael J. Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Noojan Kazemi
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Jacob R. Joseph
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Osama N. Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Clay M. Elswick
- Brain and Spine Specialists of North Texas, Arlington, Texas
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Shi A, Sun J, Chhabra A, Thakur U, Xi Y, Kohli A, Wells J. Functional outcomes are preserved in adult acetabular dysplasia with radiographic evidence of lumbosacral spine anomalies: an investigation in hip-spine syndrome. BMC Musculoskelet Disord 2022; 23:385. [PMID: 35468787 PMCID: PMC9040209 DOI: 10.1186/s12891-022-05334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Acetabular dysplasia (AD) is a debilitating condition which results in impaired hip function, leading to hip-spine syndrome with anomalies identifiable on plain radiographs. However, no study to date has investigated the association between radiographic spine anomalies and functional outcomes in AD. We hypothesize that AD patients with radiographic evidence of lumbar spine anomalies are associated with decreased function in comparison to those without such radiographic findings. Patients and methods One hundred thirty-five hips underwent a full four-view hip radiograph series, and two observers analyzed hip and spine variables using standard radiographs and obtained Castellvi grade, assessment of spondylolisthesis, and L4-S1 interpedicular distance. A comprehensive hip questionnaire was administered which included Harris Hip Score (HHS) and Hip Disability and Osteoarthritis Outcome Score (HOOS) to assess patient function. Correlations between HHS and HOOS and radiographic spinal measurements were calculated, and p-values were corrected for multiple comparison using the Holm’s method. Results Out of 135 patients, 119 were female (88.1%) and 16 were male (11.9%). Average age of presentation was 34.2 years, and average BMI was 26. There was no statistically significant correlation between Castellvi grade, presence of spondylolisthesis, or L4-S1 interpedicular distance and the patient-reported outcome measures HHS or HOOS. Conversely, a significant correlation was observed between Femoro-Epiphyseal Acetabular Roof (FEAR) index and HOOS of the contralateral hip (correlation coefficient = 0.38, adjusted p = 0.03) and Tönnis angle of AD severity and HHS of the contralateral hip (correlation coefficient = − 0.33, adjusted p = 0.04). Conclusion Severity of spinal anomalies measured by Castellvi grade and spondylolisthesis in patients with AD was not associated with decreased patient function in the ipsilateral diseased hip. To our knowledge, this is the first study to date to report the relationship between radiographically identifiable lumbosacral abnormalities and hip function in AD.
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Affiliation(s)
- Aaron Shi
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Joshua Sun
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Uma Thakur
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Yin Xi
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Ajay Kohli
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.
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Krenn VA, Fornai C, Webb NM, Woodert MA, Prosch H, Haeusler M. The morphological consequences of segmentation anomalies in the human sacrum. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:690-707. [PMID: 36787761 PMCID: PMC9303760 DOI: 10.1002/ajpa.24466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Despite the high frequency of segmentation anomalies in the human sacrum, their evolutionary and clinical implications remain controversial. Specifically, inconsistencies involving the classification and counting methods obscure accurate assessment of lumbosacral transitional vertebrae. Therefore, we aim to establish more reliable morphological and morphometric methods for differentiating between sacralizations and lumbarizations in clinical and paleontological contexts. MATERIALS AND METHODS Using clinical CT data from 145 individuals aged 14-47 years, vertebral counts and the spatial relationship between the sacrum and adjoining bony structures were assessed, while the morphological variation of the sacrum was assessed using geometric morphometrics based on varied landmark configurations. RESULTS The prevalence of lumbosacral and sacrococcygeal segmentation anomalies was 40%. Lumbarizations and sacralizations were reliably distinguishable based on the spatial relationship between the iliac crest and the upward or downward trajectory of the linea terminalis on the sacrum. Different craniocaudal orientations of the alae relative to the corpus of the first sacral vertebra were also reflected in the geometric morphometric analyses. The fusion of the coccyx (32%) was frequently coupled with lumbarizations, suggesting that the six-element sacra more often incorporate the coccyx rather than the fifth lumbar vertebra. CONCLUSIONS Our approach allowed the consistent identification of segmentation anomalies even in isolated sacra. Additionally, our outcomes either suggest that homeotic border shifts often affect multiple spinal regions in a unidirectional way, or that sacrum length is highly conserved perhaps due to functional constraints. Our results elucidate the potential clinical, biomechanical, and evolutionary significance of lumbosacral transitional vertebrae.
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Affiliation(s)
- Viktoria A Krenn
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria
| | - Cinzia Fornai
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria
- VieSID, Vienna School of Interdisciplinary Dentistry, Klosterneuburg, Austria
| | - Nicole M Webb
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
- Department of Palaeoanthropology, Senckenberg Research Institute and Natural History Museum Frankfurt, Frankfurt, Germany
- Institute of Archaeological Sciences, Senckenberg Centre for Human Evolution and Palaeoenvironment, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Mirella A Woodert
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin Haeusler
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
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Morimoto M, Sugiura K, Higashino K, Manabe H, Tezuka F, Wada K, Yamashita K, Takao S, Sairyo K. Association of spinal anomalies with spondylolysis and spina bifida occulta. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:858-864. [PMID: 35237865 DOI: 10.1007/s00586-022-07139-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/08/2022] [Accepted: 01/31/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the association of spinal anomalies with lumbar spondylolysis and spina bifida occulta (SBO). METHODS A total of 1190 patients with thoracic, abdominal, and pelvic computed tomography scans available were categorized according to the number of presacral (thoracic and lumbar) mobile vertebrae and the presence or absence of lumbosacral transitional vertebrae (LSTV). The prevalence of spondylolysis and SBO and the association of spinal anomalies with these disorders were evaluated. RESULTS Normal morphology (17 mobile vertebra with no LSTV) was found in 607 men (86.5%) and 419 women (85.9%) and about 14% of patients had anomalies. Spondylolysis was found in 74 patients (6.2%), comprising 54 men (7.7%) and 20 women (4.1%). SBO involving the lumbar spine was found in 9 men (1.3%) and 2 women (0.4%). Spondylolysis was significantly more common in men with 18 vertebrae without LSTV (21.1%) than in those with 17 vertebrae without LSTV (7.2%) (p = 0.002). The prevalence of spinal anomalies was 55.6% in men and 50.0% in women with SBO that included a lumbar level was significantly higher than in both men (13.5%, p < 0.001) and women (4.8%, p = 0.003) without SBO. CONCLUSION These findings indicate that there is a relationship between spinal anomalies and both spondylolysis and SBO, which may lead to elucidation of the mechanism of onset of spondylolysis and improve its treatment and prognosis. Awareness that patients with SBO involving the lumbar spine have an increased likelihood of a spinal anomaly may help to prevent level errors during spinal surgery.
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Affiliation(s)
- Masatoshi Morimoto
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, 3-18-15 Kuramoto, Tokushima, 770-8501, Japan.
| | - Kosuke Sugiura
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, 3-18-15 Kuramoto, Tokushima, 770-8501, Japan
| | - Kosaku Higashino
- Department of Orthopedics, Shikoku Medical Center for Children and Adults, 2-1-1 Senyu-cho, Zentsuji-shi, Kagawa, 765-8507, Japan
| | - Hiroaki Manabe
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, 3-18-15 Kuramoto, Tokushima, 770-8501, Japan
| | - Fumitake Tezuka
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, 3-18-15 Kuramoto, Tokushima, 770-8501, Japan
| | - Keizo Wada
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, 3-18-15 Kuramoto, Tokushima, 770-8501, Japan
| | - Kazuta Yamashita
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, 3-18-15 Kuramoto, Tokushima, 770-8501, Japan
| | - Shoichiro Takao
- Department of Diagnostic Radiology, Tokushima University Graduate School, Institute of Health Sciences, 3-18-15 Kuramoto, Tokushima, 770-8501, Japan
| | - Koichi Sairyo
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, 3-18-15 Kuramoto, Tokushima, 770-8501, Japan
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Mulley JF. Regulation of posterior Hox genes by sex steroids explains vertebral variation in inbred mouse strains. J Anat 2022; 240:735-745. [PMID: 34747015 PMCID: PMC8930804 DOI: 10.1111/joa.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
A series of elegant embryo transfer experiments in the 1950s demonstrated that the uterine environment could alter vertebral patterning in inbred mouse strains. In the intervening decades, attention has tended to focus on the technical achievements involved and neglected the underlying biological question: how can genetically homogenous individuals have a heterogenous number of vertebrae? Here I revisit these experiments and, with the benefit of knowledge of the molecular-level processes of vertebral patterning gained over the intervening decades, suggest a novel hypothesis for homeotic transformation of the last lumbar vertebra to the adjacent sacral type through regulation of Hox genes by sex steroids. Hox genes are involved in both axial patterning and development of male and female reproductive systems and have been shown to be sensitive to sex steroids in vitro and in vivo. Regulation of these genes by sex steroids and resulting alterations to vertebral patterning may hint at a deep evolutionary link between the ribless lumbar region of mammals and the switch from egg-laying to embryo implantation. An appreciation of the impact of sex steroids on Hox genes may explain some puzzling aspects of human disease, and highlights the spine as a neglected target for in utero exposure to endocrine disruptors.
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45
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Zhou S, Du L, Liu X, Wang Q, Zhao J, Lv Y, Yang H. Quantitative measurements at the lumbosacral junction are more reliable parameters for identifying and numbering lumbosacral transitional vertebrae. Eur Radiol 2022; 32:5650-5658. [PMID: 35258678 DOI: 10.1007/s00330-022-08613-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate quantitative parameters to identify the anatomic variation lumbosacral transitional vertebrae (LSTV) and compare them with the landmarks commonly used at present. METHODS A total of 2,845 PET/CT scans were reviewed, and the patients with 23 and 25 presacral vertebrae were included. The quantitative parameters, including the anterior-edge vertebral angle (AVA) of the lowest lumbar-type vertebra, the ratio of the length of the inferior endplate to that of the superior endplate (RISE) of the uppermost sacral-type vertebra and the lumbosacral intervertebral disc angle (LSIVDA), and the anatomical landmarks, including the iliac crest tangent (ICT) level, the iliolumbar ligament (ILL) origin level and psoas proximal insertion, were all evaluated to determine their ability to identify LSTV. RESULTS The values of AVA and RISE were significantly different between the LSTV group and the control group, and between subgroups of LSTV. The cutoff value for AVA was 73.0°, with an accuracy, sensitivity, and specificity of 91.1%, 77.5%, and 88.3%, and that for RISE was 0.79, with an accuracy, sensitivity, and specificity of 90.3%, 77.5%, and 94.2%, while that for LSIVDA was 14.15°, with an accuracy, sensitivity, and specificity of 75.9%, 65.7%, and 78.3%, to differentiate L5 sacralization from S1 lumbarization. For differentiating the controls from LSTV, the accuracy, sensitivity, and specificity of the ICT level and proximal psoas insertion were 78.0%, 70.2%, and 95.0%, versus 71.7%, 61.7%, and 94.0%. CONCLUSIONS Compared with the anatomical landmarks, the quantitative measurements at the lumbosacral junction, including AVA and RISE, may be more helpful for differentiating subgroups of LSTV especially if only lumbar spine imaging is available. KEY POINTS • The quantitative parameters, the anterior-edge vertebral angle (AVA) of the lowest lumbar-type vertebra and the ratio of the length of the inferior endplate to that of the superior endplate (RISE) of the uppermost sacral-type vertebra, are more helpful for distinguishing L5 sacralization from S1 lumbarization than the previously proposed anatomic landmarks. • AVA and RISE represent relevant changes in the curvature at the lumbosacral region and the shape of the transitional vertebral body, respectively. • AVA and RISE are easily assessed, with high intra- and inter-reader reliability.
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Affiliation(s)
- Suying Zhou
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Lin Du
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xin Liu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiqi Wang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jie Zhao
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yuchan Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Haitao Yang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Chung NS, Lee HD, Jeon CH. Reply to letter to the editor by Berry. J Orthop Sci 2022; 27:510. [PMID: 35105504 DOI: 10.1016/j.jos.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 02/09/2023]
Affiliation(s)
- Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Chang-Hoon Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea.
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Fully automated deep-learning section-based muscle segmentation from CT images for sarcopenia assessment. Clin Radiol 2022; 77:e363-e371. [DOI: 10.1016/j.crad.2022.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
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Reliability of coeliac and superior mesenteric artery origin level in lumbosacral transitional vertebrae detection and vertebral numbering. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1030355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hanhivaara J, Määttä JH, Karppinen J, Niinimäki J, Nevalainen MT. The Association of Lumbosacral Transitional Vertebrae with Low Back Pain and Lumbar Degenerative Findings in MRI: A Large Cohort Study. Spine (Phila Pa 1976) 2022; 47:153-162. [PMID: 34610612 DOI: 10.1097/brs.0000000000004244] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study of the Northern Finland Birth Cohort 1966 (NFBC1966). OBJECTIVE To evaluate the association of lumbosacral transitional vertebrae (LSTV) with low back pain (LBP) and associated degenerative findings using magnetic resonance (MR) imaging. SUMMARY OF BACKGROUND DATA LSTV is a common finding with a prevalence of 10% to 29%. LSTV causes biomechanical alterations leading to accelerated lumbar degeneration. However, its association with degenerative findings on MRI and LBP is unclear. METHODS One thousand four hundred sixty eight lumbar spine MRI scans from the NFBC1966 acquired at a mean age of 47 years were assessed for the presence of LSTV and degenerative changes. Castellvi classification was utilized to identify LSTV anatomy. Additionally, 100 controls without LSTV were collected. Self-reported LBP with a duration of more than 30 days in the past year was deemed clinically relevant. For the statistical analyses, chi square test, independent samples t test and multinomial logistic regression analyses were used. RESULTS LSTV was found in 310 (21.1%) subjects. After adjusting for age, sex, and disc degeneration (DD) sum, subjects with Castellvi type III reported prolonged LBP significantly more frequently than the controls (odds ratio [OR] = 8.9, P = 0.001). We observed a higher prevalence of facet degeneration (FD) at all levels from L3/L4 to L5/S1 in type I, and L3/L4 to L4/L5 in types II-IV. DD was more prevalent at L4/L5 in types II-IV. Disc protrusion/extrusion occurred more frequently at L3/L4 and L4/L5 in type II, and at L3/L4 in type III. Castellvi type II had a higher prevalence of type 1 Modic changes at levels from L3/L4 to L4/L5. CONCLUSION LSTVs were a common finding within this study, and Castellvi type III LSTVs were associated with LBP. Degenerative findings were associated with LSTV anatomy and occurred more commonly above the transitional level.Level of Evidence: 3.
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Affiliation(s)
- Jaakko Hanhivaara
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Juhani H Määttä
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
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50
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Byvaltsev VA, Kalinin AA, Biryuchkov MY, Khozeev DV, Dzhubayeva BA, Pestryakov YY. [Analysis of unfavorable postoperative outcomes in patients with lumbosacral junction anomalies]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:39-47. [PMID: 35170275 DOI: 10.17116/neiro20228601139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The absence of a unified diagnostic approach and heterogeneous treatment strategies in patients with lumbosacral transitional vertebra contribute to registration of contradictory data on postoperative outcomes in these patients. OBJECTIVE A retrospective analysis of postoperative outcomes in patients with degenerative lumbar spine diseases associated with lumbosacral junction anomalies and causes of unfavorable results. MATERIAL AND METHODS Lumbosacral transitional vertebra was preoperatively verified and classified according to Castellvi A.E. in 352 cases between 2007 and 2017. Full-time examination, phone and e-mail survey covered 314 (89.2%) patients throughout 5.2-year follow-up period. There were unfavorable clinical outcomes in 42 cases. We analyzed the causes of these results and relationship of surgical strategy with the type of lumbosacral junction anomaly. RESULTS Lumbosacral transitional vertebra Castellvi type IIA (30.9%) and IIIA (34.9%) prevailed. Unfavorable outcomes occurred in 7 cases after percutaneous interventions, in 12 patients after decompression surgery and in 23 patients after decompression and stabilization procedures. In all cases (n=42), redo surgery was performed: rigid fixation or extension of stabilization system in 16 cases, additional intracanal decompression in 10 patients, foraminal/extraforaminal decompression in 8 patients. Seven patients underwent repeated laser denervation. Of these, 5 patients underwent dorsal decompression without discectomy due to ineffective denervation. Correlation analysis showed the relationship between unfavorable outcomes after percutaneous procedures with LV transverse process dysplasia and sacralization, decompressive interventions with additional articular joints and lumbarization, decompression/stabilization procedures with LV transverse process dysplasia and sacralization. CONCLUSION Unfavorable outcomes occurred after percutaneous interventions for anomaly type IB and IIIB, decompressive procedures for anomaly type IIA, IIB and IV, decompression/ stabilization procedures for types IA and IIIA. It is the first report devoted to analysis of relationships between unsatisfactory postoperative outcomes, surgical technique and type of lumbosacral dysgenesis.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia
- Clinical Hospital Russian Railways-Medicine, Irkutsk, Russia
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia
- Clinical Hospital Russian Railways-Medicine, Irkutsk, Russia
| | - M Yu Biryuchkov
- Marat Ospanov West Kazakhstan Medical University, Aktobe, Kazakhstan
| | - D V Khozeev
- Irkutsk State Medical University, Irkutsk, Russia
| | - B A Dzhubayeva
- Marat Ospanov West Kazakhstan Medical University, Aktobe, Kazakhstan
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