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Kim JK, Chang MC, Park WT, Lee GW. Identification of L5 vertebra on lumbar spine radiographs using deep learning. J Int Med Res 2024; 52:3000605231223881. [PMID: 38206194 PMCID: PMC10785730 DOI: 10.1177/03000605231223881] [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: 07/06/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Deep learning is an advanced machine-learning approach that is used in several medical fields. Here, we developed a deep learning model using an object detection algorithm to identify the L5 vertebra on anteroposterior lumbar spine radiographs, and assessed its detection accuracy. METHODS We retrospectively recruited 150 participants for whom both anteroposterior whole-spine and lumbar spine radiographs were available. The anteroposterior lumbar spine radiographs of these patients were used as the input data. Of the 150 images, 105 (70%) were randomly selected as the training set, and the remaining 45 (30%) were assigned to the validation set. YOLOv5x, of the YOLOv5 family model, was used to detect the L5 vertebra area. RESULTS The mean average precisions 0.5 and 0.75 of the trained L5 detection model were 99.2% and 96.9%, respectively. The model's precision was 95.7% and its recall was 97.8%. Furthermore, 93.3% of the validation data were correctly detected. CONCLUSION Our deep learning model showed an outstanding ability to identify L5 vertebrae.
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Affiliation(s)
- Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Wook Tae Park
- Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Gun Woo Lee
- Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea
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Yoon ES, Pishgar F, Chhabra A, Del Grande F, Carrino JA. Frequency of Coexistent Spinal Segment Variants: Retrospective Analysis in Asymptomatic Young Adults. AJNR Am J Neuroradiol 2023; 45:119-126. [PMID: 38123916 PMCID: PMC10756567 DOI: 10.3174/ajnr.a8071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND PURPOSE Spinal segment variants are highly prevalent and can potentially lead to incorrect spinal enumeration and, consequently, interventions or surgeries at the wrong vertebral levels. Our aim was to assess the prevalence of spinal segment variants and to study the potential association among these variants in a population without histories of spine symptoms. MATERIALS AND METHODS Consecutive computed tomography exams of 450 young adults originally evaluated for non-spinal conditions and without a history of spinal diseases from a single institution. In addition to using descriptive statistics for reporting frequencies of spinal segment variants, the association between these variants was studied by calculating odds ratios and their 95% confidence interval. Consecutive CT exams were evaluated to determine the total number of presacral segments, presence of cervical rib, thoracolumbar transitional vertebra, iliolumbar ligament, and lumbosacral transitional vertebra. RESULTS The spinal segment distribution variants (an atypical number of presacral segments or an atypical distribution of thoracolumbar vertebrae), cervical rib, thoracolumbar transitional vertebra, and lumbosacral transitional vertebra were reported in 23.8%, 4.2%, 15.3%, and 26.4% of cases in our study population. The presence of a cervical rib or a thoracolumbar transitional vertebra was associated with concurrent lumbosacral transitional vertebra (OR = 3.28; 95% CI, 1.29-8.47 and 1.87; 95% CI, 1.08-3.20, respectively). The inability to visualize the iliolumbar ligament was also associated with the presence of cervical ribs (OR = 3.06; 95% CI, 1.18-7.80). CONCLUSIONS In a population of asymptomatic young adults, spinal segment variants are both highly prevalent with a high rate of coexistence. When a spinal segment variant (eg, transitional vertebra) is diagnosed, additional imaging might be considered for accurate spine enumeration before interventions or operations.
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Affiliation(s)
- Edward S Yoon
- From the Hospital for Special Surgery (E.S.Y., J.A.C.), New York, New York
| | | | | | - Filippo Del Grande
- Institute of Imaging of Southern of Switzerland (F.D.G.), Bellinzona, Switzerland
| | - John A Carrino
- From the Hospital for Special Surgery (E.S.Y., J.A.C.), New York, New York
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Sencan S, Azizov S, Celenlioglu AE, Bilim S, Gunduz OH. Effect of sacralization on the success of lumbar transforaminal epidural steroid injection treatment: prospective clinical trial. Skeletal Radiol 2023; 52:1949-1957. [PMID: 35705827 DOI: 10.1007/s00256-022-04089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to invastigate the effect of the sacralization on the results of transforaminal epidural steroid injection for radicular low back pain. MATERIALS AND METHODS The study included 64 patients diagnosed with radicular low back pain due to unilateral and single-level lumbar disk herniation. Patients were divided into 2 groups: patients with sacralization (Group S) and patients without lumbosacral transitional vertebrae (Group A). Injection was applied to the relevant level. Patients were evaluated with Numeric Rating Scale and Modified Oswestry Disability Index before, at week 3 and month 3 after the procedure. Sacralization presence was determined by MRI. Sacralization was categorized by anteroposterior lumbar radiography using Castellvi classification. Treatment success was considered as ≥ 50% reduction in NRS scores. RESULTS Numeric Rating Scale and Modified Oswestry Disability Index scores decreased in both groups on both week 3 and month 3 (p < 0.05). Pain scores of Group S (median value 5 (3-6)) were significantly higher than Group A ((median value 3 (0-5)) in the third month follow-up (p = 0.026), but no significant difference was observed at other time points. There was no significant difference in Modified Oswestry Disability Index scores between the groups at all follow-ups (p > 0.05). Treatment success in the third month was 44.8% in Group S and 65.6% in Group A. CONCLUSION Transforaminal epidural steroid injection is an effective and safe method for radicular low back pain. Sacralization presence should be evaluated before treatment considering that it may be a risk factor reducing treatment success.
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Affiliation(s)
- Savas Sencan
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca, Fevzi Çakmak, Mahallesi, Pendik, Istanbul, 34906, Turkey
| | - Sahin Azizov
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca, Fevzi Çakmak, Mahallesi, Pendik, Istanbul, 34906, Turkey
| | - Alp Eren Celenlioglu
- Department of Pain Medicine, University of Health Sciences Gulhane Training and Research Hospital, General Dr.Tevfik Sağlam Cd. No:1, Etlik, Ankara, 06010, Turkey.
| | - Serhad Bilim
- Department of Pain Medicine, Adıyaman University Training and Research Hospital, Ziyaretpayamlı/Adıyaman, Merkez/Adıyaman, Turkey
| | - Osman Hakan Gunduz
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca, Fevzi Çakmak, Mahallesi, Pendik, Istanbul, 34906, Turkey
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Cawley D, Shafafy R, Agu O, Molloy S. Anterior spinal fusion (ALIF/OLIF/LLIF) with lumbosacral transitional vertebra: A systematic review and proposed treatment algorithm. BRAIN & SPINE 2023; 3:101713. [PMID: 38021000 PMCID: PMC10668067 DOI: 10.1016/j.bas.2023.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 12/01/2023]
Abstract
•Key anterior approaches differences in LSTV include vascular (aortic bifurcation/iliocaval confluence), muscular (psoas) and osseus anatomy (inter-crestal tangent/pubic symphysis), when compared to non-LSTV.•There are increased surgical deviations but not significantly greater complications for anterior approaches in LSTV.•Vascular awareness while accessing L45 will be in the presence of a more cephalad ABF and ICC with sacralized L5, and access to the deeper L56 level will be in the presence of a more caudal ABF and ICC in lumbarized S1.
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Affiliation(s)
- D.T. Cawley
- Mater Private Hospital, Dublin, Republic of Ireland
- National University of Ireland, Galway, Republic of Ireland
| | - R. Shafafy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - O. Agu
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - S. Molloy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Griffith JF, Xiao F, Hilkens A, Griffith IHY, Leung JCS. Increased vertebral body area, disc and facet joint degeneration throughout the lumbar spine in patients with lumbosacral transitional vertebrae. Eur Radiol 2022; 32:6238-6246. [PMID: 35394180 DOI: 10.1007/s00330-022-08736-0] [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: 11/07/2021] [Revised: 02/25/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Lumbosacral transitional vertebrae (LSTV), developmental spinal canal stenosis, lumbar disc and facet joint degeneration are all common lumbar spine conditions. This study explores the relationship between these entities. METHODS Five hundred and five patients (254 females, 251 males), mean age 57 ± 13 years, who underwent abdominopelvic CT examinations were studied. Vertebral body cross-sectional area (CSA), spinal canal CSA, width and depth were measured from L1 to L5. The presence of LSTV was documented and the severity of disc/facet joint degeneration graded. RESULTS LSTV was present in 155 (31%) of 505 patients, being twice as common in males than in females. After controlling for age, height and weight, vertebral body CSAs from L1 to L5 in male LSTV patients were, on average, 9.8% larger than those in male non-LSTV patients (p < 0.0001 for all) while vertebral body areas at L3 and L4 were 4.5% larger in female LSTV patients than in non-LSTV female patients. Disc degeneration from L2/3 to L5/S1 and facet joint degeneration from L2/3 to L4/5 were more severe in LSTV patients. LSTV Castellvi Type II patients appear to be most prone to disc and facet degeneration. CONCLUSIONS LSTV patients, and particularly male patients, have an increased vertebral body CSA compared to non-LSTV patients throughout the lumbar spine. LSTV patients also have more severe disc and facet joint degeneration. The increase in vertebral body area may be contributing to the increased lumbar and facet joint degeneration seen in LSTV patients. KEY POINTS • LSTV patients have increased vertebral body cross-sectional area throughout their lumbar spine compared to non-LSTV patients. This vertebral body area increase was more pronounced in male patients and also apparent in younger patients with LSTV. • LSTV patients have increased disc and facet joint degeneration affecting most of the lumbar spine than non-LSTV patients. • Increased vertebral body area may contribute to the increased lumbar disc and facet joint degeneration seen in LSTV patients.
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Affiliation(s)
- James F Griffith
- Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hongkong.
| | - Fan Xiao
- Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hongkong
| | - Andrea Hilkens
- Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hongkong
| | - Isobel Han Ying Griffith
- Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hongkong
| | - Jason Chi Shun Leung
- Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hongkong
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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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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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Şencan S, Çelenlioğlu AE, Asadov R, Gündüz OH. Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica. Turk J Med Sci 2020; 50:126-131. [PMID: 31742372 PMCID: PMC7080350 DOI: 10.3906/sag-1908-167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background/aim The aim of this study was to identify predictive factors for treatment success in transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica. Materials and methods A total of 219 patients who were diagnosed with unilateral sciatica and underwent transforaminal epidural steroid injections at the level of L4-5, L5-S1, or S1 neural foramina between March 2016 and May 2018 were retrospectively analyzed. The presence of transitional vertebrae and the grade of nerve root compression were evaluated by a radiologist. Data including age, sex, body mass index, duration of symptoms, injection levels, and pain scores were recorded. Pain scores were evaluated using the numerical rating scale. Treatment success was defined as a ≥50% decrease in pain scores at 3 months. Results The study included 118 female and 101 male patients with a mean age of 43.65 ± 12.18 years. The mean duration of symptoms was 25.64 ± 2.17 weeks. Although the duration of symptoms was longer in patients for whom treatment failed, it did not reach statistical significance. Decreased pain scores at 1 h had a significant effect on treatment success (p = 0.012, odds ratio (OR): 1.015, 95% confidence interval (CI), 1.003–1.026). Conclusions Our study results suggest that a decreased pain score at 1 h is a predictor for a favorable three-month response to transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica.
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Affiliation(s)
- Savaş Şencan
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Alp Eren Çelenlioğlu
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ruslan Asadov
- Department of Radiology, Baku Medical Plaza, Baku, Azerbaijan
| | - Osman Hakan Gündüz
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
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Is Lumbosacral Transitional Vertebra Associated with Degenerative Lumbar Spinal Stenosis? BIOMED RESEARCH INTERNATIONAL 2019; 2019:3871819. [PMID: 31281838 PMCID: PMC6590608 DOI: 10.1155/2019/3871819] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/18/2019] [Accepted: 05/26/2019] [Indexed: 11/18/2022]
Abstract
The aim of this study was to shed light on the association between lumbosacral transitional vertebra (LSTV) and degenerative lumbar spinal stenosis (DLSS). A cross-sectional retrospective study was performed on 165 individuals that were diagnosed with clinical picture of DLSS (age range: 40-88 years; sex ratio: 80M/85F) and 180 individuals without DLSS related symptoms (age range: 40-99 years; sex ratio: 90M/90F). All participants had undergone high-resolution CT scan for the lumbar region in the same position. We also used the volume rendering method to obtain three-dimensional CT images of the lumbosacral area. Both males and females in the stenosis group manifest greater prevalence of LSTV than their counterparts in the control group (P<0.001). Furthermore, the presence of LSTV increases the likelihood of degenerative spinal stenosis (odds ratio= 3.741, P<0.001). In the control group, LSTV was more common in males, and sacral slope angle of males was significantly greater in LSTV group compared to non-LSTV. This study indicates that LSTV was significantly associated with symptomatic DLSS.
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GÜNDÜZ N, DURUKAN G, ESER MB, ASLAN A, KABAALİOĞLU A. Role of iliac crest tangent in correct numbering of lumbosacral transitional vertebrae. Turk J Med Sci 2019; 49:184-189. [PMID: 30764596 PMCID: PMC7350831 DOI: 10.3906/sag-1807-258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background/aim The iliac crest tangent (ICT) has recently emerged as a reliable landmark to correctly number the lumbosacral transitional vertebrae (LSTV). We retrospectively evaluated the reproducibility and accuracy of the ICT as a landmark in subjects without disc degeneration. Materials and methods Fifty-eight patients with LSTV [19 female, 41 (26–52) years] and 55 controls without LSTV [23 female, 40 (26–55) years] who had undergone spinal computed tomography were included. The ICT was drawn on the coronal images, with the cursor in the sagittal view set to the posterior ⅓ of the vertebral body located one level above the LSTV. When more than 1.25 vertebral body was counted below the ICT, the LSTV was considered as S1, otherwise it was considered as L5. The gold standard was counting the vertebrae craniocaudally. Results The interobserver agreement was good for determining ICT level (Cohen’s kappa = 0.78, P < 0.001). The rate of correct numbering by ICT in the LSTV group was significantly less than in the controls (43.1% vs. 96.4%, respectively, P < 0.001). Patients with sacralization had a significantly lower correct numbering rate than patients with lumbarization (33.3% vs. 63.2%, respectively, P = 0.03). Conclusion ICT does not seem to be a reliable landmark for correct numbering of LSTV in patients with no intervertebral disc degeneration.
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Affiliation(s)
- Nesrin GÜNDÜZ
- Department of Radiology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbulTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Gülçin DURUKAN
- Department of Radiology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbulTurkey
| | - Mehmet Bilgin ESER
- Department of Radiology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbulTurkey
| | - Ahmet ASLAN
- Department of Radiology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbulTurkey
| | - Adnan KABAALİOĞLU
- Department of Radiology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbulTurkey
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Ropars F, Mesrar J, Ognard J, Querellou S, Rousset J, Garetier M. Psoas proximal insertion as a simple and reliable landmark for numbering lumbar vertebrae on MRI of the lumbar spine. Eur Radiol 2018; 29:2608-2615. [PMID: 30413962 DOI: 10.1007/s00330-018-5798-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the value of psoas muscle proximal insertion for correct numbering of the lumbar vertebrae in MRI, in particular in case of lumbosacral transitional vertebra (LSTV). METHODS Two radiologists assessed 477 MRI scans of the lumbar spine with a sagittal localizer sequence on the whole spine for numbering vertebrae caudally from C2. Proximal insertion of the psoas was determined as the most proximal vertebra with psoas over half of its body on coronal T2 STIR sequence. The last lumbar vertebra was named considering both its number and the presence or absence of LSTV according to Castellvi classification. These same parameters were also assessed on 207 PET-CT scans of another cohort including the whole spine. RESULTS Proximal insertion of the psoas was L1 in 94.1% of cases: 98.5% in case of modal anatomy, 81.4% in case of LSTV, and 51.7% in case of missing or supernumerary lumbar vertebra without LSTV. There was no statistically significant difference between MRI and CT data. The inter-reader agreement for determination of psoas proximal insertion was excellent (kappa = 0.96). CONCLUSION Proximal insertion of the psoas muscle is a helpful marker for correct numbering of the lumbar vertebrae in MRI and to detect a complete lumbosacral segmentation anomaly. KEY POINTS • Proximal insertion of the psoas muscle can be easily identified on a coronal T2 STIR sequence. • Psoas proximal insertion on the spine almost always designates the first lumbar vertebra and is helpful to accurately number all lumbar vertebrae, especially in case of lumbosacral transitional vertebra. • Conversely, when psoas muscle does not insert five lumbar bodies above the apparent lumbosacral joint, the probability of variation in the number of lumbar vertebrae is high.
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Affiliation(s)
- François Ropars
- Department of Radiology, Military Teaching Hospital Clermont-Tonnerre, Rue du colonel Fonferrier, 29240, Brest Cedex 9, France.
| | - J Mesrar
- Department of Radiology, University Hospital La Cavale Blanche, Brest, France
| | - J Ognard
- Department of Radiology, University Hospital La Cavale Blanche, Brest, France
| | - S Querellou
- Department of Nuclear Medicine, University Hospital Morvan, Brest, France
| | - J Rousset
- Department of Radiology, Military Teaching Hospital Clermont-Tonnerre, Rue du colonel Fonferrier, 29240, Brest Cedex 9, France
| | - M Garetier
- Department of Radiology, Military Teaching Hospital Clermont-Tonnerre, Rue du colonel Fonferrier, 29240, Brest Cedex 9, France
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Yun S, Park S, Park JG, Huh JD, Shin YG, Yun JH. Spinal Enumeration by Morphologic Analysis of Spinal Variants: Comparison to Counting in a Cranial-To-Caudal Manner. Korean J Radiol 2018; 19:1140-1146. [PMID: 30386145 PMCID: PMC6201970 DOI: 10.3348/kjr.2018.19.6.1140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the spinal enumeration methods that establish the first lumbar vertebra in patients with spinal variants. Materials and Methods Of the 1446 consecutive patients who had undergone computed tomography of the spine from March 2012 to July 2016, 100 patients (62 men, 38 women; mean age, 47.9 years; age range, 19-88 years) with spinal variants were included. Two radiologists (readers 1 and 2) established the first lumbar vertebra through morphologic analysis of the thoracolumbar junction, and labeled the vertebra by counting in a cranial-to-caudal manner. Inter-observer agreement was established. Additionally, reader 1 detected the 20th vertebra under the assumption that there are 12 thoracic vertebra, and then classified it as a thoracic vertebra, lumbar vertebra, or thoracolumbar transitional vertebra (TLTV), on the basis of morphologic analysis. Results The first lumbar vertebra, as established by morphologic analysis, was labeled by each reader as the 21st segment in 65.0% of the patients, as the 20th segment in 31.0%, and as the 19th segment in 4.0%. Inter-observer agreement between the two readers in determining the first lumbar vertebra, based on morphologic analysis, was nearly perfect (κ value: 1.00). The 20th vertebra was morphologically classified as a TLTV in 60.0% of the patients, as the first lumbar segment in 31.0%, as the second lumbar segment in 4.0%, and as a thoracic segment in 5.0%. Conclusion The establishment of the first lumbar vertebra using morphologic characteristics of the thoracolumbar junction in patients with spinal variants was consistent with the morphologic traits of vertebral segmentation.
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Affiliation(s)
- Sam Yun
- Department of Radiology, Kosin University Gospel Hospital, Busan 49267, Korea
| | - Sekyoung Park
- Department of Radiology, Kosin University Gospel Hospital, Busan 49267, Korea
| | - Jung Gu Park
- Department of Radiology, Kosin University Gospel Hospital, Busan 49267, Korea
| | - Jin Do Huh
- Department of Radiology, Kosin University Gospel Hospital, Busan 49267, Korea
| | - Young Gyung Shin
- Department of Radiology, Kosin University Gospel Hospital, Busan 49267, Korea
| | - Jong Hyouk Yun
- Department of Radiology, Kosin University Gospel Hospital, Busan 49267, Korea
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14
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Khashoggi KG, Hafiz RM, Bock YM, Kaki AM. Determination of lumbosacral transitional vertebrae in kidney urinary bladder x-ray films in the Saudi population. Saudi Med J 2018; 38:794-797. [PMID: 28762430 PMCID: PMC5556294 DOI: 10.15537/smj.2017.8.19341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigated the rate of occurrence of lumbosacral transitional vertebrae (LSTV), spinal variant, in kidney urinary bladder (KUB) plain radiographs in a Saudi population. Methods: Between January 2012 to January 2015, KUB plain films obtained from patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, were reviewed, and the presence or absence of LSTV was documented and classified as incomplete or complete. Patients who had evidence of spinal surgery that would obscure the view were excluded. Results: A total of 2078 patients underwent KUB examinations during the study period; LSTV anomalies were detected in 158 of these. Sacralization was present in 153 (96.8%) of this cohort, while lumbarization was present in 5 (3.2%). A total of 136 (86.1%) of the sacralized segments were of the incomplete type, whereas 17 (10.7%) were complete. Of the lumbarized vertebrae, 3 (1.8%) were incomplete, and 2 (1.2%) were complete. The most frequent type in men was type Ib (28.5%) for sacralized segments, and type IIb for lumbarized segments (0.6%). In women, type Ia was the most common form of sacralized segments (11.3%) and type IIb was the most common form of lumbarized segments (2.8%). Conclusion: The prevalence of LSTV in Saudi patients is 7.6%, with a higher incidence of sacralization than lumbarization. Further studies with larger sample sizes and longer follow-up time are needed to demonstrate the clinical significance thereof.
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Affiliation(s)
- Khalid G Khashoggi
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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15
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Lian J, Levine N, Cho W. A review of lumbosacral transitional vertebrae and associated vertebral numeration. 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 2018; 27:995-1004. [PMID: 29564611 DOI: 10.1007/s00586-018-5554-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/01/2018] [Accepted: 03/16/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE To review the current literature on methods of accurate numeration of vertebral segments in patients with Lumbosacral transitional vertebrae (LSTVs). LSTVs are a common congenital anomaly of the L5-S1 junction. While their clinical significance has been debated, unquestionable is the need for their identification prior to spinal surgery. We hypothesize that there are no reliable landmarks by which we can accurately number transitional vertebrae, and thus a full spinal radiograph is required. METHODS A Pubmed and EMBASE search using various combinations of specific key words including "LSTV", "lumbosacral transitional vertebrae", "count", "vertebral numbering", and "number" was performed. RESULTS The gold standard for spinal segment numeration in patients with LSTV remains whole spine imaging and counting caudally, starting from C2. If whole spine imaging is not available, the use of the iliac crest tangent sign on coronal magnetic resonance imaging (MRI) has fairly reliable sensitivity and specificity (81 and 64-88%, respectively) for accurate numeration of LSTV. The role of paraspinal anatomic markers such as the right renal artery, superior mesenteric artery, aortic bifurcation, and conus medullaris, for identification of vertebral levels is unreliable and should not be used. CONCLUSIONS A sagittal whole spine view should be added as a scout view when patients obtain lumbar MRI to standardize the vertebral numbering technique. To date, there has been no other method for accurate numeration of a transitional vertebral segment, other than counting caudally from C2. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Jayson Lian
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Nicole Levine
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Woojin Cho
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA. .,Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Ave, 6th Fl., Bronx, NY, 10467, USA.
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16
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Peckham ME, Hutchins TA, Stilwill SE, Mills MK, Morrissey BJ, Joiner EAR, Sanders RK, Stoddard GJ, Shah LM. Localizing the L5 Vertebra Using Nerve Morphology on MRI: An Accurate and Reliable Technique. AJNR Am J Neuroradiol 2017; 38:2008-2014. [PMID: 28775057 DOI: 10.3174/ajnr.a5311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/23/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Multiple methods have been used to determine the lumbar vertebral level on MR imaging, particularly when full spine imaging is unavailable. Because postmortem studies show 95% accuracy of numbering the lumbar vertebral bodies by counting the lumbar nerve roots, attention to lumbar nerve morphology on axial MR imaging can provide numbering clues. We sought to determine whether the L5 vertebra could be accurately localized by using nerve morphology on MR imaging. MATERIALS AND METHODS One hundred eight cases with full spine MR imaging were numbered from the C2 vertebral body to the sacrum with note of thoracolumbar and lumbosacral transitional states. The origin level of the L5 nerve and iliolumbar ligament were documented in all cases. The reference standard of numbering by full spine imaging was compared with the nerve morphology numbering method. Five blinded raters evaluated all lumbar MRIs with nerve morphology technique twice. Prevalence and bias-adjusted κ were used to measure interrater and intrarater reliability. RESULTS The L5 nerve arose from the 24th presacral vertebra (L5) in 106/108 cases. The percentage of perfect agreement with the reference standard was 98.1% (95% CI, 93.5%-99.8%), which was preserved in transitional and numeric variation states. The iliolumbar ligament localization method showed 83.3% (95% CI, 74.9%-89.8%) perfect agreement with the reference standard. Inter- and intrarater reliability when using the nerve morphology method was strong. CONCLUSIONS The exiting L5 nerve can allow accurate localization of the corresponding vertebrae, which is essential for preprocedure planning in cases where full spine imaging is not available. This neuroanatomic method displays higher agreement with the reference standard compared with previously described methods, with strong inter- and intrarater reliability.
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Affiliation(s)
- M E Peckham
- From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.)
| | - T A Hutchins
- From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.)
| | - S E Stilwill
- Musculoskeletal Division (S.E.S., M.K.M., R.K.S.)
| | - M K Mills
- Musculoskeletal Division (S.E.S., M.K.M., R.K.S.)
| | - B J Morrissey
- Departments of Radiology and Imaging Sciences (B.J.M., E.A.R.J.), University of Utah Health Sciences Center, Salt Lake City, Utah
| | - E A R Joiner
- Departments of Radiology and Imaging Sciences (B.J.M., E.A.R.J.), University of Utah Health Sciences Center, Salt Lake City, Utah
| | - R K Sanders
- Musculoskeletal Division (S.E.S., M.K.M., R.K.S.)
| | - G J Stoddard
- From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.)
| | - L M Shah
- From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.)
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Role of Anatomical Landmarks in Identifying Normal and Transitional Vertebra in Lumbar Spine Magnetic Resonance Imaging. Asian Spine J 2017; 11:365-379. [PMID: 28670404 PMCID: PMC5481591 DOI: 10.4184/asj.2017.11.3.365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/06/2016] [Accepted: 11/11/2016] [Indexed: 11/08/2022] Open
Abstract
Study Design Retrospective study. Purpose Identification of transitional vertebra is important in spine imaging, especially in presurgical planning. Pasted images of the whole spine obtained using high-field magnetic resonance imaging (MRI) are helpful in counting vertebrae and identifying transitional vertebrae. Counting vertebrae and identifying transitional vertebrae is challenging in isolated studies of lumbar spine and in studies conducted in low-field MRI. An incorrect evaluation may lead to wrong-level treatment. Here, we identify the location of different anatomical structures that can help in counting and identifying vertebrae. Overview of Literature Many studies have assessed the vertebral segments using various anatomical structures such as costal facets (CF), aortic bifurcation (AB), inferior vena cava confluence (IC), right renal artery (RRA), celiac trunk (CT), superior mesenteric artery root (SR), iliolumbar ligament (ILL) psoas muscle (PM) origin, and conus medullaris. However, none have yielded any consistent results. Methods We studied the locations of the anatomical structures CF, AB, IC, RRA, CT, SR, ILL, and PM in patients who underwent whole spine MRI at our department. Results In our study, 81.4% patients had normal spinal segmentation, 14.7% had sacralization, and 3.8% had lumbarization. Vascular landmarks had variable origin. There were caudal and cranial shifts with respect to lumbarization and sacralization. In 93.8% of cases in the normal group, ILL emerged from either L5 alone or the adjacent disc. In the sacralization group, ILL was commonly seen in L5. In the lumbarization group, ILL emerged from L5 and the adjacent disc (66.6%). CFs were identified at D12 in 96.9% and 91.7% of patients in the normal and lumbarization groups, respectively. The PM origin was observed from D12 or D12–L1 in most patients in the normal and sacralization groups. Conclusions CF, PM, and ILL were good identification markers for D12 and L5, but none were 100% accurate.
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Josiah DT, Boo S, Tarabishy A, Bhatia S. Anatomical differences in patients with lumbosacral transitional vertebrae and implications for minimally invasive spine surgery. J Neurosurg Spine 2017; 26:137-143. [PMID: 27661564 DOI: 10.3171/2016.6.spine1691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The objective of this study was to investigate the neurovascular and anatomical differences in patients with lumbosacral transitional vertebrae (LSTV) and the associated risk of neurovascular injury in minimally invasive spine surgery.
METHODS
The authors performed a retrospective study of CT and MR images of the lumbar spine obtained at their institution between 2010 and 2014. The following characteristics were evaluated: level of the iliac crest in relation to the L4–5 disc space, union level of the iliac veins and arteries in relation to the L4–5 disc space, distribution of the iliac veins and inferior vena cava according to the different Moro zones (A, I, II, III, IV, P) at the L4–5 disc space, and the location of the psoas muscle at the L4–5 disc space. The findings were compared with findings on images obtained in 28 age- and sex-matched patients without LSTV who underwent imaging studies during the same time period.
RESULTS
Twenty-eight patients (12 male, 16 female) with LSTV and the required imaging studies were identified; 28 age- and sex-matched patients who had undergone CT and MRI studies of the thoracic and lumbar spine imaging but did not have LSTV were selected for comparison (control group). The mean ages of the patients in the LSTV group and the control group were 52 and 49 years, respectively. The iliac crest was located at a mean distance of 12 mm above the L4–5 disc space in the LSTV group and 4 mm below the L4–5 disc space in the controls. The iliac vein union was located at a mean distance of 8 mm above the L4–5 disc space in the LSTV group and 2.7 mm below the L4–5 disc space in the controls. The iliac artery bifurcation was located at a mean distance of 23 mm above the L4–5 disc space in the LSTV group and 11 mm below the L4–5 disc space in controls. In patients with LSTV, the distribution of iliac vein locations was as follows: Zone A, 7.1%; Zone I only, 78.6%; Zone I encroaching into Zone II, 7.1%; and Zone II only, 7.1%. In the control group, the distribution was as follows: Zone A only, 17.9%; Zone A encroaching into Zone I, 75%; and Zone I only, 7.1%. There were no iliac vessels in Zone II in the control group. The psoas muscle was found to be rising away laterally and anteriorly from the vertebral body more often in patients with LSTV, resulting in the iliac veins being found in the “safe zone” only 14% of the time, greatly increasing the risk of vascular injury.
CONCLUSIONS
In patients with LSTV, the iliac crest is more likely to be above the L4–5 disc space, which increases the technical challenges of a lateral approach. The location of the psoas muscle rising away laterally and ventrally in patients with LSTV compared with controls and with the union of the iliac veins occurring more often above the L4–5 disc space increases the risk for iatrogenic vascular injury at the L4–5 level in this patient population.
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Affiliation(s)
| | - SoHyun Boo
- 2Radiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Abdul Tarabishy
- 2Radiology, West Virginia University School of Medicine, Morgantown, West Virginia
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19
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Tins BJ, Balain B. Incidence of numerical variants and transitional lumbosacral vertebrae on whole-spine MRI. Insights Imaging 2016; 7:199-203. [PMID: 26873359 PMCID: PMC4805617 DOI: 10.1007/s13244-016-0468-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives This study sets out to prospectively investigate the incidence of transitional vertebrae and numerical variants of the spine. Materials and methods Over a period of 28 months, MRIs of the whole spine were prospectively evaluated for the presence of transitional lumbosacral vertebrae and numerical variants of the spine. Results MRI of the whole spine was evaluated in 420 patients, comprising 211 female and 209 male subjects. Two patients had more complex anomalies. Lumbosacral transitional vertebrae were seen in 12 patients: eight sacralised L5 (3 male, 5 female) and four lumbarised S1 (3 male, 1 female). The incidence of transitional vertebrae was approximately 3.3. % (14/418). Thirty-two (7.7 %) of 418 patients had numerical variants of mobile vertebrae of the spine without transitional vertebrae. The number of mobile vertebrae was increased by one in 18 patients (12 male, 6 female), and the number was decreased by one in 14 patients (4 male, 10 female). Conclusions Numerical variants of the spine are common, and were found to be almost 2.5 times as frequent as transitional lumbosacral vertebrae in the study population. Only whole-spine imaging can identify numerical variants and the anatomical nature of transitional vertebrae. The tendency is toward an increased number of mobile vertebrae in men and a decreased number in women. Main messages • Numerical variants of the spine are more common than transitional vertebrae. • Spinal numerical variants can be reliably identified only with whole-spine imaging. • Increased numbers of vertebrae are more common in men than women. • Transitional lumbosacral vertebrae occurred in about 3.3 % of the study population. • The incidence of numerical variants of the spine was about 7.7 %.
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Affiliation(s)
- Bernhard J Tins
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Twmpath Lane, Oswestry, Shropshire, SY10 7AG, UK.
| | - Birender Balain
- Department of Spinal Surgery, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, Shropshire, UK
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Park SK, Park JG, Kim BS, Huh JD, Kang H. Thoracolumbar junction: morphologic characteristics, various variants and significance. Br J Radiol 2016; 89:20150784. [PMID: 26670155 DOI: 10.1259/bjr.20150784] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: This study aimed to assess the types of vertebral segments at the thoracolumbar junction, as they relate to the most caudal ribs, to evaluate the reliability of this assessment using axial CT with curved planar reformatting (CPR) images, to describe the morphologic characteristics of a thoracolumbar transitional vertebra (TLTV), to introduce a new classification system for the TLTV and to evaluate the reliability of the classification system using axial CT with CPR images. METHODS: This was a retrospective review of 744 consecutive patients who underwent spine CT imaging that included the thoracolumbar junction. Two radiologists (Readers 1 and 2) independently evaluated the axial CT with CPR images for all cases (n = 744). Each radiologist differentiated the vertebral segments at the thoracolumbar junction as TLTV or non-TLTV (thoracic segment or lumbar segment). In addition, each radiologist classified the 94 patients with the TLTV using a novel classification system. Interobserver agreement between the two radiologists regarding the differentiation of vertebral segments at the thoracolumbar junction was analysed with kappa statistics. Similarly, intra- and interobserver agreement regarding TLTV classification was analysed with kappa statistics. RESULTS: Interobserver agreement between the two readers with respect to the differentiation of vertebral segments at the thoracolumbar junction via axial CT with CPR images was nearly perfect (κ-value: 0.959). Interobserver agreement between the two readers with respect to TLTV classification using axial CT with CPR images was nearly perfect (κ-value: 0.846). In addition, intraobserver agreement for Reader 1 was also nearly perfect (κ-value: 0.877). CONCLUSION: Morphologic analysis of the thoracolumbar junction may help accurate spinal enumeration. ADVANCES IN KNOWLEDGE: Consideration of various variants at the thoracolumbar junction should help radiologists and clinicians to interpret the morphology of the thoracolumbar junction. This may facilitate communication with the referring clinician, thereby reducing the error in spinal enumeration.
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Affiliation(s)
- Se K Park
- Department of Radiology, Kosin University Gospel Hospital, Busan, South Korea
| | - Jung G Park
- Department of Radiology, Kosin University Gospel Hospital, Busan, South Korea
| | - Beom S Kim
- Department of Radiology, Kosin University Gospel Hospital, Busan, South Korea
| | - Jin D Huh
- Department of Radiology, Kosin University Gospel Hospital, Busan, South Korea
| | - Hee Kang
- Department of Radiology, Kosin University Gospel Hospital, Busan, South Korea
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