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Mattatia J, Valentin H, Fredj P, Nguyen-Kim P, Sanchez G, Demir R, Roque P. Leg length discrepancies (LLD): An etiology to be considered in its proper measure. A critical and historical review. J Bodyw Mov Ther 2024; 38:391-398. [PMID: 38763584 DOI: 10.1016/j.jbmt.2024.01.036] [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: 10/01/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Studies of leg-length discrepancies (LLD) have been the subject of debate for almost 200 years. A large number of studies have emerged, most frequently using assessment criteria based on painful symptoms or joint damage. DEVELOPMENT While many authors argue for a threshold of 10-20 mm to establish a link between pain and LLD, most publications based on radiography show lesion stigmata on lumbar, hip and knee joints as early as 6 mm. This would be linked to comorbidities. DISCUSSION Some studies argue forcefully that leg-length correction below 20 mm is of no benefit. The authors of the present article, on the other hand, evoke the notion of lesion risks in the absence of correction, even for small deviations in the presence of certain associated factors and according to their importance. CONCLUSION The authors argue for the need to define in the future a lesion significance score that would not be correlated to painful symptomatology, but rather to the presence of co-morbidities such as age, anatomical variability, sports practice and/or patients' professional activities. Other parameters, such as mobility, should also be taken into consideration, while gender, height and weight do not appear to be significantly related.
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Affiliation(s)
- Jérémie Mattatia
- Ecole Supérieure d'Ostéopathie (ESO), 8 Rue Alfred Nobel, 77420, Champs-sur-Marne, France.
| | - Hugo Valentin
- Cabinet de podologie, 1 rue du Dr Leray, 75013, Paris, France
| | - Pierre Fredj
- Cabinet de kinésithérapie, 38 rue Cavendish, 75019, Paris, France
| | - Pascal Nguyen-Kim
- Cabinet de kinésithérapie et d'ostéopathie, 21 Boulevard Davout, 75020, Paris, France
| | - Guillaume Sanchez
- Cabinet de podologie, 2 Rue du Temple, 95880, Enghien-les-Bains, France
| | - Rahsan Demir
- Ecole Supérieure d'Ostéopathie (ESO), 8 Rue Alfred Nobel, 77420, Champs-sur-Marne, France
| | - Philippe Roque
- Ecole Supérieure d'Ostéopathie (ESO), 8 Rue Alfred Nobel, 77420, Champs-sur-Marne, France
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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 PMCID: PMC11412131 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] [Received: 10/06/2023] [Accepted: 02/13/2024] [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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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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Jenkins AL, Chung RJ, O'Donnell J, Hawks C, Jenkins S, Lazarus D, McCaffrey T, Terai H, Harvie C, Matsoukas S. Redefining the Treatment of Lumbosacral Transitional Vertebrae for Bertolotti Syndrome: Long-Term Outcomes Utilizing the Jenkins Classification to Determine Treatment. World Neurosurg 2023; 175:e21-e29. [PMID: 36898630 DOI: 10.1016/j.wneu.2023.03.012] [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: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Using the Jenkins classification, we propose a strategy of shaving down hypertrophic bone, unilateral fusion, or bilateral fusion procedures to achieve pain reduction and improve quality of life for patients with Bertolotti syndrome. METHODS We reviewed 103 patients from 2012 through 2021 who had surgically treated Bertolotti syndrome. We identified 56 patients with Bertolotti syndrome and at least 6 months of follow-up. Patients with iliac contact preoperatively were presumed to be more likely to have hip pain that could respond to surgical treatment, and those patients were tracked for those outcomes as well. RESULTS Type 1 patients (n = 13) underwent resection. Eleven (85%) had improvement, 7 (54%) had good outcome, 1 (7%) had subsequent surgery, 1 (7%) was suggested additional surgery, and 2 (14%) were lost to follow-up. In Type 2 patients (n = 36), 18 underwent decompressions and 18 underwent fusions as a first line. Of the 18 patients treated with resection an interim analysis saw 10 (55%) with failure and needing subsequent procedures. With subsequent procedure, 14 (78%) saw improvement. For fusion surgical patients, 16 (88%) saw some improvement and 13 (72%) had a good outcome. In Type 4 patients (n = 7), 6 (86%) did well with unilateral fusion, with durable benefit at 2 years. In patients who had hip pain preoperatively (n = 27), 21 (78%) had improvement of hip pain postoperatively. CONCLUSIONS The Jenkins classification system provides a strategy for patients with Bertolotti syndrome who fail conservative therapy. Patients with Type 1 anatomy respond well to resection procedures. Patients with Type 2 and Type 4 anatomy respond well to fusion procedures. These patients respond well in regard to hip pain.
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Affiliation(s)
- Arthur L Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Jenkins NeuroSpine, Private Practice, New York, New York, USA.
| | - Richard J Chung
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - John O'Donnell
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Charlotte Hawks
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Sarah Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | | | - Tara McCaffrey
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Hiromi Terai
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Camryn Harvie
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Jenkins AL, O'Donnell J, Chung RJ, Jenkins S, Hawks C, Lazarus D, McCaffrey T, Terai H, Harvie C. Redefining the Classification for Bertolotti Syndrome: Anatomical Findings in Lumbosacral Transitional Vertebrae Guide Treatment Selection. World Neurosurg 2023; 175:e303-e313. [PMID: 36965661 DOI: 10.1016/j.wneu.2023.03.077] [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: 01/05/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE We present the Jenkins classification for Bertolotti syndrome or symptomatic lumbosacral transitional vertebra (LSTV) and compare this with the existing Castellvi classification for patients presenting for treatment. METHODS We performed a retrospective cohort study of 150 new patients presenting for treatment of back, hip, groin, and/or leg pain from July 2012 through February 2022. Using magnetic resonance imaging, computed tomography, and radiography, the patients with a radiographic finding of LSTV, an appropriate clinical presentation, and identification of LSTV as the primary pain generator via diagnostic injections were diagnosed with Bertolotti syndrome. Patients for whom conservative treatment had failed and who underwent surgery to address their LSTV were included in the present study. RESULTS The Castellvi classification excludes 2 types of anatomic variants: the prominent anatomic side and the potential transverse process and iliac crest contact. Of 150 patients with transitional anatomy, 103 (69%) were identified with Bertolotti syndrome using the Jenkins classification and received surgery (46 men [45%] and 57 women [55%]). Of the 103 patients, 90 (87%) underwent minimally invasive surgery. The patients presented with pain localized to the back (n = 101; 98%), leg (n = 79; 77%), hip (n = 51; 49%), and buttock (n = 52; 50%). Only 84 of the Jenkins classification patients (82%) met any of the Castellvi criteria. All 19 patients for whom the Castellvi classification failed had had type 1 anatomy using the Jenkins system and underwent surgery (decompression, n = 16 [84%]; fusion, n = 1 [5%]; fusion plus decompression, n = 2 [11%]). Of these 19 patients, 17 (89%) had improved pain scores. The 19 patients exclusively diagnosed via the Jenkins classification had no significant differences in improved pain compared with those diagnosed using the Castellvi classification. CONCLUSIONS The Jenkins classification improves on the prior Castellvi classification to more comprehensively describe the functional anatomy, identify uncaptured anatomy, and better predict optimal surgical procedures to treat those with Bertolotti syndrome.
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Affiliation(s)
- Arthur L Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Jenkins NeuroSpine, New York, New York, USA.
| | | | | | - Sarah Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Jenkins NeuroSpine, New York, New York, USA
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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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Muacevic A, Adler JR. Morphometric Examination of the Sacroiliac Region and Variable Positions of the Sacral Auricular Surface: Anatomical Classification and Importance. Cureus 2023; 15:e33792. [PMID: 36819403 PMCID: PMC9927799 DOI: 10.7759/cureus.33792] [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] [Accepted: 01/15/2023] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Anatomical variations of the sacrum involve alterations in the number of sacral segments, auricular surface area, and neural arch dimensions and are associated with biomechanical, surgical, and obstetric implications. Due to the complex functional structure of the sacroiliac (SI) joints, it was aimed to evaluate their morphometric structure, classify the sacrum, and group different locations of the auricular surface in the sacrums. METHODS Sex determination was made in 91 dry human sacra. Determination of the alpha angle on the sagittal axis of the auricular surface of the sacrum and classification of the auricular surface of the sacrum was performed. The sacra were studied to determine the position and extent of their auricular surfaces in relation to the sacral segments. Specimens were grouped as "normal," "high-up," and "low-down" auricular surface-bearing sacra. The sacral surface areas were measured, and SI joints were classified into three types morphologically (types I, II, and III). The depth and anterior-posterior length of the cranial, middle, and caudal impressions observed in the posterior sacrum and anterior-posterior lengths were measured. RESULTS The measurements made for sex determination showed that 46 of the sacra were from females and 45 were from males. The alpha angle on the sagittal axis of the sacral auricular surface was found to be greatest at the level of the first posterior sacral foramina. While the most common sacrum type was Type III, the least common type was Type I. The surface area of facies auricularis was found to be larger in males than in females. With regard to facies auricularis in all sacrum groups, although it covered approximately 2.5 sacral vertebrae, there was a difference in the location of facies auricularis in the sacral vertebrae. A statistically significant difference was found between right and left in the depth values of the impressions in the dorsal surface of the sacrum (p <0.05). CONCLUSION The position of the auricular surface in the sacrum differed among individuals. These differences are associated with variable load-bearing in the SI joints. The biomechanical classification of the sacrum and localization of the auricular surface can provide information about the anatomic source of low back pain or help predict the location of low back pain. Changes in the synovial surface morphology of the SI joints may elicit sacroiliac joint pain. This study was conducted because it is considered that the location of the auricular surface can significantly affect load-bearing patterns of the sacrum.
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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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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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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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12
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Jin L, Yin Y, Chen W, Zhang R, Guo J, Tao S, Guo Z, Hou Z, Zhang Y. Role of the Lumbosacral Transition Vertebra and Vertebral Lamina in the Pathogenesis of Lumbar Disc Herniation. Orthop Surg 2021; 13:2355-2362. [PMID: 34791784 PMCID: PMC8654657 DOI: 10.1111/os.13122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/30/2021] [Accepted: 06/02/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of lumbosacral transition vertebrae (LSTVs) in both the normal population and the lumbar disc herniation (LDH) population and to determine the risk factors for LDH. METHODS Between January 2019 and September 2020, all patients aged 18-39 years and underwent an anteroposterior (AP) X-ray of the lumbar vertebrae were retrospective reviewed in our institution. Those patients who were diagnosed with LDH were eligible for inclusion in the LDH group. During the same period, those patients admitted to our hospital who underwent an anteroposterior X-ray of the lumbar spine and had not been diagnosed with LDH were included in the control group. Those patients with disease that might affect the lumbar anatomy were excluded from both groups. The type of LSTV was classified according to the Castellvi classification. The height of the lumbar vertebral lamina was evaluated through the h/H index. The inter- and intra-observer reliability was evaluated by one senior radiologist and one senior orthopedist using intraclass correlation coefficient (ICC). The association between the LSTV and the herniation level was also investigated. Binary logistic regression was used to explore the association of different factors between the LDH group and the control group. RESULTS Two hundred LDH patients (115 male and 85 female) and 200 individuals (108 male and 92 female) were investigated retrospectively. The prevalence of LSTVs was 71.5% (n = 143) in the LDH group and 34.0% (n = 68) in the control group. The most frequent LSTV types were type Ib and type IIa. The inter- and intra-observer ICCs of the measurement of "h/H" index and the classification of LSTV were all "excellent" (ICC > 0.90). The median h/H index in the control group was significantly higher than that in the LDH group (0.28 (0.26, 0.31) vs 0.34 (0.31, 0.37), P = 0.000). The distribution of the Castellvi classification in the L4/5 and L5/S1 herniation patients was significantly different (P = 0.048). LSTVs, BMI and the h/H index were closely associated with LDH, with odds ratios of 3.06 (95% CI: 2.12-4.43), 1.23 (95% CI: 1.13-1.33) and 0.09 (95% CI: 0.05-0.15), respectively. The incidence of L4/5 disc herniation in patients with an LSTV was significantly more common than that in patients with L5/S1 disc herniation (P = 0.048). CONCLUSION The prevalence of LSTVs was 34.0% in the control group and 71.5% in the LDH group; LSTVs and BMI were positively correlated with LDH, and h/H was negatively correlated with LDH.
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Affiliation(s)
- Lin Jin
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Yingchao Yin
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Wei Chen
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Ruipeng Zhang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Jialiang Guo
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Shiwu Tao
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Zheming Guo
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China
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Mahato NK. Re-examining the Spectrum of Lumbosacral Transitional Dysmorphisms: Quantifying Joint Asymmetries and Evaluating the Anatomy of Screw Fixation Corridors. Neurospine 2019; 17:294-303. [PMID: 31319660 PMCID: PMC7136114 DOI: 10.14245/ns.1938102.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Although a wide range of sacral dysmorphisms has been documented with lumbosacral transitional vertebrae (LSTV) variations, quantitative characterization of the upper segment morphology and articular anatomy across the array of lumbosacral transitions are hardly found in the literature. This study presents LSTV anomalies as a series of sequential morphological changes (the LSTV spectrum) and quantitatively compares 6 LSTV subtypes with normative sacral dimensions including the anatomy at the upper sacral segments used for percutaneous sacroiliac screw insertion.
Methods Seven linear dimensions were measured from LSTV subtypes and normal sacral variants from dried adult sacral specimens. The auricular, superior articular and facet surface areas were quantified. Obliquity and thickness of osseous corridors used for sacroiliac screw fixation were measured. Data were statistically compared within and between LSTV subtypes and the normal variants.
Results LSTVs presented a wide range of morphometric differences in comparison to the normal bones. Grouping LSTV according to auricular surface positions (high, normal, and low) demonstrated significant between-group differences in the obliquity and thickness at the S1 and S2 segmental corridors.
Conclusion Frequent occurrence of LSTV in the general population may require evaluation of anatomical parameters in these variations for safe sacroiliac instrumentation around this region.
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Affiliation(s)
- Niladri Kumar Mahato
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of The West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
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14
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Mahato NK. Asymmetric sacroiliac joint anatomy in partial lumbosacral transitional variations: Potential impact on clinical testing in sacral dysfunctions. Med Hypotheses 2019; 124:110-113. [PMID: 30798903 DOI: 10.1016/j.mehy.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/02/2019] [Accepted: 02/01/2019] [Indexed: 12/01/2022]
Abstract
Lumbosacral transitional vertebrae (LSTV) anomalies may present as bio-mechanical dysfunctions leading to low back pain (LBP). Unilateral or incomplete/partial LSTVs have been documented to be associated with significant sacroiliac joint (SIJ) joint asymmetries. Objective evaluation of outcomes from routine clinical testing for sacral dysfunctions on these subsets of LSTV cannot be found in the literature. Based on quantitative studies available on LSTV-associated anatomical variations at the SIJ, this study hypothesizes probable outcomes of standard palpatory clinical tests used to evaluate sacral dysfunctions in unilateral LSTV anomalies. Since LSTV is reported in a sizeable percentage in the general population and due to its proposed etiological relationship with LBP, these entities warrant attention in terms of the anatomical bases of related clinical assessments and their outcomes, as proposed in this hypothesis.
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Affiliation(s)
- Niladri Kumar Mahato
- Department of Pre-Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago; Former Post-Doctoral Researcher, Ohio Musculoskeletal & Neurological Institute (OMNI), Department of Biomedical Sciences, Ohio University, Athens 45701, OH, USA.
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15
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Ravikanth R, Majumdar P. Bertolotti's syndrome in low-backache population: Classification and imaging findings. Tzu Chi Med J 2019; 31:90-95. [PMID: 31007488 PMCID: PMC6450150 DOI: 10.4103/tcmj.tcmj_209_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Lumbosacral transition vertebrae (LSTVs) are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTVs are often inaccurately detected and classified on standard anteroposterior radiographs and magnetic resonance imaging. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increases accuracy. The diagnosis of symptomatic LSTV is considered with appropriate patient history and imaging studies. This study aimed to classify the anatomical variations in LSTV and determine, by plain radiography, if there exists a relationship between sacralization and low backache (LBP). Materials and Methods: Five hundred lumbosacral radiographs of LBP patients were examined after obtaining prior consent from the patient and approval from the “institutional ethics committee.” Data collection consisted of the patient's age at the time of imaging gender and number of lumbar vertebral bodies. Dysplastic transverse processes were classified according to the Castellvi radiographic classification system. The incidence of sacralization in patients and the control groups was reported, and the anomaly was compared according to the groups. Results: Of these patient groups, 134 were classified as positive for sacralization, which resulted in an incidence of 26.8%. The most common anatomical variant was Castellvi Type IA (7.6%). There were no statistically significant differences between men and women who had anomaly (P = 0.9256). Higher incidences of Type IB and Type IIB were found in men, but those results were not statistically significant (P = 0.133 and P = 0.581, respectively) when compared with the female group. Daily frequency and intensity of LBP were assessed in patients using visual analog scale (VAS) scores. The patients with LBP and no malformation reported an average pain level on the VAS for pain of 2.2 versus 5.2 in patients with LBP and a transitional vertebra, respectively. Conclusion: Based on our data, we conclude that lumbosacral transitional segments are a common cause in the low-backache population. However, no relationship was found between age and genders in this study. However, in comparison with the nonspecific low-backache group, the VAS scores were significantly higher and the pain duration was significantly longer in the LSTV group.
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Affiliation(s)
- Reddy Ravikanth
- Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Pooja Majumdar
- Department of Medicine, INHS Sanjeevani, Ernakulam, Kerala, India
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Lumbosacral transitional vertebra in the young men population with low back pain: anatomical considerations and degenerations (transitional vertebra types in the young men population with low back pain). Radiol Med 2018; 124:375-381. [PMID: 30547357 DOI: 10.1007/s11547-018-0974-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION To evaluate the prevalence of subtypes of congenital lumbosacral transition vertebra (LSTV) in young male populations with low back pain (LBP) and their relationship to lumbar disc and facet degeneration. MATERIALS AND METHODS 1875 patients (male, aged; 18-40 years) with LBP were investigated retrospectively. Standard lumbar MRI protocol of sagittal, and axial T1 weighted images (WI) and T2 WI and coronal short tau inversion recovery (STIR) T2 WI were obtained. Castellvi classification of LSTV were used for subtyping. The level and above the level of LSTV were evaluated for the lumbar disc space and facet degeneration based on grading methods which compares subtype groups with each other. RESULTS Prevalence of LSTV was 32% (600 of 1875). The most frequent LSTV types were type I (dysplastic enlarged transverse process; 66.5%) and type II (pseudoarticulation; 21.8%). Eight percent of the patients were type III (fusion) and 3.6% patients type IV (one transverse process fused and one with pseudoarticulation). The most commonly detected LSTV types were type I + II (88%) and all bilateral LSTV types were seen much more than unilateral types (bilateral versus unilateral 63.2%, 33.2%). The LSTV type I highly correlated with the disc degeneration and facet arthrosis. But the groups with higher grade of disc degeneration were type IV and III. CONCLUSION In young male patients with LBP, LSTV was found to be high in frequency and mostly occurred to be subtype I. LSTV type I and associated disk and facet degeneration were found to be remarkable in this group. Coronal T2 STIR images are useful in showing lumbosacral region anomalies and variants, and should be included in the routine lumbar MRI protocol.
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Jancuska JM, Spivak JM, Bendo JA. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome. Int J Spine Surg 2015; 9:42. [PMID: 26484005 DOI: 10.14444/2042] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. This review will focus on the clinical significance of LSTV, disruptions in normal spine biomechanics, imaging techniques, diagnosis, and treatment. METHODS A Pubmed search using the specific key words "LSTV," "lumbosacral transitional vertebrae," and "Bertolotti's Syndrome" was performed. The resulting group of manuscripts from our search was evaluated. RESULTS LSTV are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTV are often inaccurately detected and classified on standard AP radiographs and MRI. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increase accuracy. Uncertainty regarding the cause, clinical significance, and treatment of LSTV persists. Some authors suggest an association between LSTV types II and IV and low back pain. Pseudoarticulation between the transverse process and the sacrum creates a "false joint" susceptible to arthritic changes and osteophyte formation potentially leading to nerve root entrapment. The diagnosis of symptomatic LSTV is considered with appropriate patient history, imaging studies, and diagnostic injections. A positive radionuclide study along with a positive effect from a local injection helps distinguish the transitional vertebra as a significant pain source. Surgical resection is reserved for a subgroup of LSTV patients who fail conservative treatment and whose pain is definitively attributed to the anomalous pseudoarticulation. CONCLUSIONS Due to the common finding of low back pain and the wide prevalence of LSTV in the general population, it is essential to differentiate between symptoms originating from an anomalous psuedoarticulation from other potential sources of low back pain. Further studies with larger sample sizes and longer follow-up time would better demonstrate the effectiveness of surgical resection and help guide treatment.
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Affiliation(s)
| | - Jeffrey M Spivak
- Department of Orthopaedic Surgery and Hospital for Joint Diseases, New York University School of Medicine, New York, NY, USA
| | - John A Bendo
- Department of Orthopaedic Surgery and Hospital for Joint Diseases, New York University School of Medicine, New York, NY, USA
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