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Cho S, Ahn YJ, Lee YJ, Ha IH, Lee YS. Integrative Korean medicine treatment for low back pain with radiculopathy caused by Bertolotti syndrome: A CARE-compliant article and retrospective review of medical records. Medicine (Baltimore) 2024; 103:e39720. [PMID: 39287242 PMCID: PMC11404960 DOI: 10.1097/md.0000000000039720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
RATIONALE Bertolotti syndrome (BS) is characterized by radiculopathy caused by structural anomalies. Despite the structural deformity, conservative treatment is predominantly recommended due to surgery-related complications. Because of the diagnosis complexity, the incidence and contributing factors of BS, remain controversial. We report the case of a patient with BS who was treated with integrative Korean medicine (IKM). Moreover, we evaluated the epidemiological characteristics of lumbosacral transitional vertebrae (LSTV) from medical records of patients diagnosed with LSTV at 4 different medical clinics of Korean medicine. PATIENT CONCERNS A 33-year-old male patient with low back pain and severe radiculopathy was diagnosed with BS (Castellvi Type II) on magnetic resonance imaging at a local orthopedic clinic. Additionally, the medical records of patients with BS who had been treated with IKM in 4 different institutions of Korean medicine were analyzed, and the characteristics of patients suffering from BS were identified. DIAGNOSES, INTERVENTIONS, AND OUTCOMES The patient underwent IKM treatment for 40 days as an inpatient. The patient's condition was assessed using the Euroqol 5-dimension index and Oswestry Disability Index, and symptom severity was measured using the Numeric Rating Scale. IKM was effective in improving pain and functional disability without causing any adverse effects. In a retrospective review of medical records, the study identified symptom trends reported by patients with LSTV. LESSONS IKM demonstrates potential efficacy in BS management, with notable trends in LSTV-related symptomatology warranting further investigation.
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Affiliation(s)
- Sohyun Cho
- Jaseng Korean Medicine Hospital, Seoul, Korea
| | | | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
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2
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Oh J, Kim B, Oh G, Hwangbo Y, Ye JC. End-to-End Semi-Supervised Opportunistic Osteoporosis Screening Using Computed Tomography. Endocrinol Metab (Seoul) 2024; 39:500-510. [PMID: 38721637 PMCID: PMC11220219 DOI: 10.3803/enm.2023.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGRUOUND Osteoporosis is the most common metabolic bone disease and can cause fragility fractures. Despite this, screening utilization rates for osteoporosis remain low among populations at risk. Automated bone mineral density (BMD) estimation using computed tomography (CT) can help bridge this gap and serve as an alternative screening method to dual-energy X-ray absorptiometry (DXA). METHODS The feasibility of an opportunistic and population agnostic screening method for osteoporosis using abdominal CT scans without bone densitometry phantom-based calibration was investigated in this retrospective study. A total of 268 abdominal CT-DXA pairs and 99 abdominal CT studies without DXA scores were obtained from an oncology specialty clinic in the Republic of Korea. The center axial CT slices from the L1, L2, L3, and L4 lumbar vertebrae were annotated with the CT slice level and spine segmentation labels for each subject. Deep learning models were trained to localize the center axial slice from the CT scan of the torso, segment the vertebral bone, and estimate BMD for the top four lumbar vertebrae. RESULTS Automated vertebra-level DXA measurements showed a mean absolute error (MAE) of 0.079, Pearson's r of 0.852 (P<0.001), and R2 of 0.714. Subject-level predictions on the held-out test set had a MAE of 0.066, Pearson's r of 0.907 (P<0.001), and R2 of 0.781. CONCLUSION CT scans collected during routine examinations without bone densitometry calibration can be used to generate DXA BMD predictions.
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Affiliation(s)
- Jieun Oh
- Healthcare AI Team, National Cancer Center, Goyang, Korea
| | - Boah Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Gyutaek Oh
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, Goyang, Korea
| | - Jong Chul Ye
- Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 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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4
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Jiang L, Du X, Pan Z, Yuan Y, Battié MC, Wang Y. Lumbar disc herniation in juveniles: A case-control study of MRI characteristics and etiological insights. J Orthop Res 2023; 41:2685-2693. [PMID: 37165707 DOI: 10.1002/jor.25598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/03/2023] [Accepted: 05/08/2023] [Indexed: 05/12/2023]
Abstract
Lumbar disc herniation (LDH) is rare in juveniles. LDH occurring at age 20 years or younger is referred to as juvenile disc herniation (JDH). While adult LDH is regarded as an advanced stage of disc degeneration, it remains unclear why intervertebral discs rupture in youth. This study aimed to characterize magnetic resonance imaging (MRI) findings of JDH and investigate possible etiological factors. From 2013 to 2020, JDH patients and controls were identified and interviewed to assess demographics, general lifestyles, and family histories. MRIs were evaluated for disc degeneration, epiphyseal ring separation, Modic changes and endplate lesions. The relationships between JDH and suspected risk factors were examined. A total of 297 JDH patients (199 boys and 98 girls, age 17.3 ± 2.1 years) and 185 controls (age 17.1 ± 2.4 years) were studied. Age, body mass index, exposures to daily physical labor, regular exercise, and daily sitting time were similar between JDH cases and controls. A family medical history of serious back pain was more common in JDH patients than in controls (59.4% vs. 26.5%, p < 0.001), as well as family history of clinically established LDH (45.0% vs. 12.4%, p < 0.001). Epiphyseal ring separation was identified in 102 (29.2%) herniated discs in 91 (36.4%) JDH patients, while occurring in only 5 (1.4%) control participants (p < 0.001). Overall, severe disc degeneration was not a prominent finding in JDH patients. In conclusion, epiphyseal ring separation was a common magnetic resonance feature in JDH. Findings suggest a genetically mediated developmental model of JDH, rather than a model of premature disc degeneration.
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Affiliation(s)
- Lejian Jiang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaotian Du
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zongyou Pan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Yuan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Michele C Battié
- Department of Physical Therapy, Faculty of Health Sciences, Western University, Canada
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Meng D, Boyer E, Pujades S. Vertebrae localization, segmentation and identification using a graph optimization and an anatomic consistency cycle. Comput Med Imaging Graph 2023; 107:102235. [PMID: 37130486 DOI: 10.1016/j.compmedimag.2023.102235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/23/2023] [Accepted: 03/24/2023] [Indexed: 05/04/2023]
Abstract
Vertebrae localization, segmentation and identification in CT images is key to numerous clinical applications. While deep learning strategies have brought to this field significant improvements over recent years, transitional and pathological vertebrae are still plaguing most existing approaches as a consequence of their poor representation in training datasets. Alternatively, proposed non-learning based methods take benefit of prior knowledge to handle such particular cases. In this work we propose to combine both strategies. To this purpose we introduce an iterative cycle in which individual vertebrae are recurrently localized, segmented and identified using deep-networks, while anatomic consistency is enforced using statistical priors. In this strategy, the transitional vertebrae identification is handled by encoding their configurations in a graphical model that aggregates local deep-network predictions into an anatomically consistent final result. Our approach achieves the state-of-the-art results on the VerSe20 challenge benchmark, and outperforms all methods on transitional vertebrae as well as the generalization to the VerSe19 challenge benchmark. Furthermore, our method can detect and report inconsistent spine regions that do not satisfy the anatomic consistency priors. Our code and model are openly available for research purposes.1.
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Affiliation(s)
- Di Meng
- Inria, Univ. Grenoble Alpes, CNRS, Grenoble INP, LJK, France.
| | - Edmond Boyer
- Inria, Univ. Grenoble Alpes, CNRS, Grenoble INP, LJK, France
| | - Sergi Pujades
- Inria, Univ. Grenoble Alpes, CNRS, Grenoble INP, LJK, France
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Poolman AM, Wessels Q, Schoor AV, Keough N. Thoracolumbar transitional vertebrae: Quantitative differentiation and associated numeric variation in the vertebral column using skeletal remains. J Anat 2023. [PMID: 37024435 DOI: 10.1111/joa.13865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 01/18/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Transitional vertebrae at the thoracolumbar region are called thoracolumbar transitional vertebrae (TLTV) and retain physical features from the thoracic and lumbar regions. Since TLTV were first classified 40 years ago, there has been much discrepancy regarding its features, identification and clinical relevance. Vertebral body levels are used in the medical field as a frame of reference to locate specific organs, vessels, nerves or landmarks. Any numeric variation or deviation in the vertebral column may lead to clinical errors. Previous findings have suggested a high association between numeric variation and the presence of TLTV. Therefore, the aim of this study was to identify the types of TLTV observed and to identify any possible associated numeric variation in the vertebral column. This study also aimed to validate the established technique to quantitatively differentiate TLTV from T12 and L1 at the thoracolumbar junction using skeletal remains from a South African population group. Skeletal remains (n = 187) remains from the Pretoria bone collection were assessed. Measurements were taken of the angle of the superior zygapophyseal processes of the last thoracic vertebra (T12), the first lumbar (L1), and identified TLTV. The results indicate a TLTV prevalence of 35% (n = 66/187). The results show that each vertebral type (T12, L1, TLTV) fall into independent confidence intervals: T12 is 188° ± 9.22 (CI: 187° < μ < 189.6°), 110° ± 7.52 (CI: 109.2° < μ < 111.3°) in L1, and 135° ± 24.51 (CI: 130.4° < μ < 139.1°) in the TLTV. This study observed that 70% of cases with TLTV was associated with numeric variation in the spine, both homeotic and meristic and that TLTV has a 35% prevalence. The results clearly show that quantitative morphometric analysis can effectively differentiate TLTV from other vertebral types at the thoracolumbar junction in skeletal remains.
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Affiliation(s)
- Anneli M Poolman
- Division of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Quenton Wessels
- Division of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Albert Van Schoor
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Natalie Keough
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
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Abul K, Özmen BB, Yücekul A, Zulemyan T, Yılgör Ç, Alanay A. If you look this way, you will see it: cranial shift in adolescent idiopathic scoliosis. Spine Deform 2023; 11:105-114. [PMID: 35921040 DOI: 10.1007/s43390-022-00560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Anatomical variations in the spine can be seen in each transitional border, either toward the skull as 'cranial shifts' or away as caudal shifts. Cranial shifting (CS) occurs when there is presence of occipitalization, C7 cervical costae or prominent transverse processes, thoracolumbar transitional vertebrae (TLTV) at T12 level, L5 sacralization, and sacrococcygeal fusion. We termed the coexistence of sacralization of L5 and absence or remarkable reduction of T12 rib size in AIS as Abul cranial shift (ACS). In this descriptive clinical study, primary aim was to investigate the incidence of ACS in AIS. METHODS Retrospective analysis of 187 surgically treated AIS cases was performed. Demographic data were recorded. The incidence of the specific set of anatomic variations including lumbosacral transitional vertebrae, TLTV, transverse process changes in C7 vertebrae, and posterior lumbosacral neural arch cleft formations (NACf) were evaluated in the radiological images. RESULTS 36 (19%) of 187 cases had ACS. ACS was detected in only 1 of 19 male cases (5%), while in 35 of 168 female cases (21%). Forty-one cases had sacralization of L5 (22%). There were only eleven pair of ribs in 14 (7%) of 187 cases and 10 (28%) of 36 ACS cases. Forty cases had NACf (21%). ACS and NACf coexistence were observed in 8 (22%) of 36 ACS cases. CONCLUSION Accurate spinal column assessment is critical in adolescent idiopathic scoliosis (AIS). ACS may be observed in up to one in five AIS cases and its presence should not be neglected to avoid wrong level surgery.
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Affiliation(s)
- Kadir Abul
- Department of Orthopedics and Traumatology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey.
| | - Berk Barış Özmen
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altuğ Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Çağlar Yılgör
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Plessis AMD, Wessels Q, Schoor AV, Keough N. Congenital malformations in the vertebral column: associations and possible embryologic origins. Anat Cell Biol 2022; 55:399-405. [PMID: 36071544 PMCID: PMC9747346 DOI: 10.5115/acb.22.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 01/02/2023] Open
Abstract
Cases of associations between random spinal congenital defects have previously been reported, yet several questions remain unanswered. Firstly, why are associations between what seems to be random combinations of vertebral malformations observed? Secondly, is there a common event or pattern that connects the associated defects? Therefore, this study aimed to identify congenital defects in the vertebral column and also to determine whether any associations, if present, between vertebral malformations exist. This article consequently discusses the possible embryological disruptions that may lead to the formation of various defects in the vertebral column. A random skeletal sample (n=187) was selected from the Pretoria Bone Collection housed in the Department of Anatomy, University of Pretoria (Ethics 678/2018). The sample was evaluated to determine the frequencies of spinal congenital defects in each set of remains. Identifiable congenital malformations were observed in 48.1% (n=90/187) of the sample. The results demonstrated a high probability of association between the different defects observed in the vertebral column. Findings are of value as they provide a reasonable explanation to why seemingly random cases of associations have been reported by several authors. This study is clinically relevant as severe spinal defects have been shown to have high morbidity in patients and mortality in infants.
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Affiliation(s)
- Anneli M. Du Plessis
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa,Department Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia,Corresponding author: Anneli M. Du Plessis, Department of Anatomy, School of Medicine, University of Namibia, Windhoek 9000, Namibia, E-mail: /
| | - Quenton Wessels
- Department Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Albert Van Schoor
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa
| | - Natalie Keough
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa,Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
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Hornung AL, Hornung CM, Mallow GM, Barajas JN, Espinoza Orías AA, Galbusera F, Wilke HJ, Colman M, Phillips FM, An HS, Samartzis D. Artificial intelligence and spine imaging: limitations, regulatory issues and future direction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2007-2021. [PMID: 35084588 DOI: 10.1007/s00586-021-07108-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND As big data and artificial intelligence (AI) in spine care, and medicine as a whole, continue to be at the forefront of research, careful consideration to the quality and techniques utilized is necessary. Predictive modeling, data science, and deep analytics have taken center stage. Within that space, AI and machine learning (ML) approaches toward the use of spine imaging have gathered considerable attention in the past decade. Although several benefits of such applications exist, limitations are also present and need to be considered. PURPOSE The following narrative review presents the current status of AI, in particular, ML, with special regard to imaging studies, in the field of spinal research. METHODS A multi-database assessment of the literature was conducted up to September 1, 2021, that addressed AI as it related to imaging of the spine. Articles written in English were selected and critically assessed. RESULTS Overall, the review discussed the limitations, data quality and applications of ML models in the context of spine imaging. In particular, we addressed the data quality and ML algorithms in spine imaging research by describing preliminary results from a widely accessible imaging algorithm that is currently available for spine specialists to reference for information on severity of spine disease and degeneration which ultimately may alter clinical decision-making. In addition, awareness of the current, under-recognized regulation surrounding the execution of ML for spine imaging was raised. CONCLUSIONS Recommendations were provided for conducting high-quality, standardized AI applications for spine imaging.
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Affiliation(s)
- Alexander L Hornung
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | | | - G Michael Mallow
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - J Nicolas Barajas
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Alejandro A Espinoza Orías
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | | | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Ulm, Germany
| | - Matthew Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL, 60612, USA.
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Vereecke E, Herregods N, Morbée L, Laloo F, Chen M, Jans L. Imaging of Structural Abnormalities of the Sacrum: The Old Faithful and Newly Emerging Techniques. Semin Musculoskelet Radiol 2022; 26:469-477. [PMID: 36103888 DOI: 10.1055/s-0042-1754342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The sacrum and sacroiliac joints pose a long-standing challenge for adequate imaging because of their complex anatomical form, oblique orientation, and posterior location in the pelvis, making them subject to superimposition. The sacrum and sacroiliac joints are composed of multiple diverse tissues, further complicating their imaging. Varying imaging techniques are suited to evaluate the sacrum, each with its specific clinical indications, benefits, and drawbacks. New techniques continue to be developed and validated, such as dual-energy computed tomography (CT) and new magnetic resonance imaging (MRI) sequences, for example susceptibility-weighted imaging. Ongoing development of artificial intelligence, such as algorithms allowing reconstruction of MRI-based synthetic CT images, promises even more clinical imaging options.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
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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: 15] [Impact Index Per Article: 7.5] [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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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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13
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Cheng L, Jiang C, Huang J, Jin J, Guan M, Wang Y. Lumbosacral Transitional Vertebra Contributed to Lumbar Spine Degeneration: An MR Study of Clinical Patients. J Clin Med 2022; 11:2339. [PMID: 35566465 PMCID: PMC9104340 DOI: 10.3390/jcm11092339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/26/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to comprehensively characterize degenerative findings associated with various types of lumbosacral transitional vertebra (LSTV) on magnetic resonance images. Three hundred and fifty patients with LSTV (52.3 ± 10.9 years), including 182 Castellvi type I, 107 type II, 43 type III, and 18 type IV, and 179 controls without LSTV (50.6 ± 13.1 years), were studied. Discs, endplates, and posterior vertebral structures were assessed and compared to those of controls for the most caudal three discs on MRIs. There were no differences in degenerative findings between patients with type I LSTV and controls. For types III and IV, the transitional discs had smaller sizes, lower Pfirrmann scores, and lower rates of disc bulging (2.3% and 5.6% vs. 39.1%), osteophytes (2.3% vs. 15.1%), disc herniation (2.3% and 5.6% vs. 31.8%), and Modic changes (2.3% and 5.6% vs. 16.8%) than controls. However, the cranial discs had more severe Pfirrmann scores, disc narrowing and spinal canal narrowing, and greater rates of disc herniation (41.9% and 50.0% vs. 25.7%), endplate defects (27.9% and 33.3% vs. 14.4%) and spondylolisthesis (18.6% vs. 7.3%) than controls. Type II LSTV was associated with degenerative findings in the cranial segments but to a lesser degree, as compared with type III/IV LSTV. Thus, Castellvi type III/IV LSTV predisposed the adjacent spinal components to degeneration and protected the transitional discs. Type II LSTV had significant effects in promoting transitional and adjacent disc degeneration. Type I LSTV was not related to spinal degeneration.
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Affiliation(s)
| | | | | | | | - Ming Guan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.C.); (C.J.); (J.H.); (J.J.)
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.C.); (C.J.); (J.H.); (J.J.)
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14
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Cordover JB, Fleisig GS, Raszewski JA, Dumont AS, Cordover AM. Return to sport after lumbar microdiscectomy in high school and college age athletes. World Neurosurg 2022; 163:e516-e521. [PMID: 35421588 DOI: 10.1016/j.wneu.2022.04.025] [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: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have reported return to play (RTP) rates for athletes after lumbar discectomy, but not specifically younger athletes. The purpose of this study was to evaluate RTP rate of young athletes after lumbar microdiscectomy. METHODS Medical records for a single spine surgeon were reviewed to identify lumbar microdiscectomy patients. Patients were included if they were 21 years old or younger at the time of surgery and were athletes. 38 patients (25 male, 13 female) were identified, with mean age at surgery of 19 years. Level of herniated nucleus pulposus, variant anatomy, degenerative change, gender, preoperative blocks, ring apophyseal fractures, and duration of symptoms from onset until surgery were recorded. Patients were contacted to determine when and if they RTP. RESULTS Most patients had degenerative changes at the time of surgery, with a mean Pfirrmann score of 2.2. The average time from onset of symptoms until surgery was 11 months. All patients were reached for follow-up at an average 51 months post-op. 71% returned to play at an average of 4.5 months. There were no statistical differences in Pfirrmann Grade and RTP rates between high school and collegiate athletes, between males and females, nor between patients with two-level and one-level discectomies. Pfirrmann Grade was not significantly different between patients who RTP and those who did not RTP. CONCLUSIONS The prognosis for returning to competitive sports after lumbar microdiscectomy in young athletes is good. RTP rate and Pfirrmann Grade were not related to gender, sport level, or discectomy level.
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Affiliation(s)
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA.
| | | | - Aaron S Dumont
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Andrew M Cordover
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
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15
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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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16
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Fully automated deep-learning section-based muscle segmentation from CT images for sarcopenia assessment. Clin Radiol 2022; 77:e363-e371. [DOI: 10.1016/j.crad.2022.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
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17
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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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18
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Olstad K, Aasmundstad T, Kongsro J, Grindflek E. Osteochondrosis and other lesions in all intervertebral, articular process and rib joints from occiput to sacrum in pigs with poor back conformation, and relationship to juvenile kyphosis. BMC Vet Res 2022; 18:44. [PMID: 35042517 PMCID: PMC8764802 DOI: 10.1186/s12917-021-03091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Computed tomography (CT) is used to evaluate body composition and limb osteochondrosis in selection of breeding boars. Pigs also develop heritably predisposed abnormal curvature of the spine including juvenile kyphosis. It has been suggested that osteochondrosis-like changes cause vertebral wedging and kyphosis, both of which are identifiable by CT. The aim of the current study was to examine the spine from occiput to sacrum to map changes and evaluate relationships, especially whether osteochondrosis caused juvenile kyphosis, in which case CT could be used in selection against it. Whole-body CT scans were collected retrospectively from 37 Landrace or Duroc boars with poor back conformation scores. Spine curvature and vertebral shape were evaluated, and all inter-vertebral, articular process and rib joints from the occiput to the sacrum were assessed for osteochondrosis and other lesions. Results Twenty-seven of the 37 (73%) pigs had normal spine curvature, whereas 10/37 (27%) pigs had abnormal curvature and all of them had wedge vertebrae. The 37 pigs had 875 focal lesions in articular process and rib joints, 98.5% of which represented stages of osteochondrosis. Five of the 37 pigs had focal lesions in other parts of vertebrae, mainly consisting of vertebral body osteochondrosis. The 10 pigs with abnormal curvature had 21 wedge vertebrae, comprising 10 vertebrae without focal lesions, six ventral wedge vertebrae with ventral osteochondrosis lesions and five dorsal wedge vertebrae with lesions in the neuro-central synchondrosis, articular process or rib joints. Conclusions Computed tomography was suited for identification of wedge vertebrae, and kyphosis was due to ventral wedge vertebrae compatible with heritably predisposed vertebral body osteochondrosis. Articular process and rib joint osteochondrosis may represent incidental findings in wedge vertebrae. The role of the neuro-central synchondrosis in the pathogenesis of vertebral wedging warrants further investigation. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-03091-6.
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19
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Liebrand B, Brakel K, Boon A, van der Weegen W, Wal SVD, Vissers KC. Diagnostic treatment-level discrepancies in patients with lumbosacral radicular pain and lumbar spine anomalies. Reg Anesth Pain Med 2021; 47:177-182. [PMID: 34921051 DOI: 10.1136/rapm-2021-103174] [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: 09/07/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lumbosacral transitional vertebra can result in an anomalous number of lumbar vertebrae associated with wrong level treatment. The primary aim of this study was to characterize discrepancies between reported referring levels and levels from MRI reports with treated levels. The secondary aim was to analyze interobserver variability between a pain physician and a radiologist when determining levels and classifying lumbosacral transitional vertebrae. METHODS Between February 2016 and October 2019, a retrospective case series of prospectively collected data of the affected levels mentioned in referrals, MRI reports and treated levels was performed. The counting process, level determination, classification of lumbosacral transitional vertebrae and a secondary control were carried out by independent researchers using a standard methodology. RESULTS Of the 2443 referrals, 143 patients had an anomalous number of lumbar vertebrae; of these, 114 were included for analysis. The vertebral level noted in the patient's file, in the referral, and the reported level of treatment differed in 40% of these cases. The vertebral level between the MRI reports and treatment differed in 46% of cases. The interobserver reliability (radiologist vs pain physician) for classifying a transitional vertebra was fair ((κ=0.40) and was substantial (κ=0.70) when counting the vertebrae. CONCLUSION In the presence of lumbar spine anomalies, we report a high prevalence of discrepancies between referral levels and MRI pathological findings with treatment levels. Further research is needed to better understand clinical implications.
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Affiliation(s)
- Bart Liebrand
- Department of Anaesthesiology and Pain Medicine, St Anna Hospital, Geldrop, The Netherlands
| | - Koen Brakel
- Department of Radiology, St Anna Hospital, Geldrop, The Netherlands
| | - Arthur Boon
- Department of Neurology, St Anna Hospital, Geldrop, The Netherlands
| | | | - Selina van der Wal
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kris Cp Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
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20
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Tatara Y, Niimura T, Sekiya T, Mihara H. Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae. JB JS Open Access 2021; 6:JBJSOA-D-20-00167. [PMID: 34278183 PMCID: PMC8280013 DOI: 10.2106/jbjs.oa.20.00167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The presence of a thoracolumbar transitional vertebra (TLTV) and/or lumbosacral transitional vertebra (LSTV) may cause wrong-site surgery and problems while measuring spinopelvic parameters, including pelvic incidence and lumbar lordosis. The Castellvi classification of LSTV addresses coronal images but not sagittal or axial images. Therefore, it is unclear how LSTV differs from the normal lumbosacral anatomy. We aimed to investigate the lumbosacral anatomy and vertebral numbering in patients with TLTV and/or LSTV. We performed computed tomography (CT) to identify TLTV, to number presacral vertebrae accurately, and to analyze morphological differences in each LSTV type.
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Affiliation(s)
- Yasunori Tatara
- Spine Center, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | | | | | - Hisanori Mihara
- Spine Center, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
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21
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Yoon SH, Kim SA, Lee GY, Kim H, Lee JH, Leem J. Using magnetic resonance imaging to measure the depth of acupotomy points in the lumbar spine: A retrospective study. Integr Med Res 2020; 10:100679. [PMID: 33898243 PMCID: PMC8054160 DOI: 10.1016/j.imr.2020.100679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 01/02/2023] Open
Abstract
Background The acupotomy is an acupuncture device recently used to stimulate lumbar vertebrae such as transverse processes (TPs) and facet joints (FJs). However, there are many organs, nerves, and blood vessels, which can lead to side effects if the needle misses the treatment target. Therefore, information regarding appropriate insertion depths, which is currently lacking, could facilitate its safe use. We retrospectively investigated the depth from the skin to the TP and FJ of the lumbar vertebrae, using magnetic resonance imaging (MRI). Methods This retrospective chart review was conducted at a single medical centre in Korea. From 55,129 patient records, 158 subjects were selected. Perpendicular depth from the skin to the left and right TPs and FJs was measured using T1-weighted sagittal plane MRI. Depth differences between the left and right sides were evaluated using the paired t-test and analysis of covariance (body mass index [BMI] as a covariate). The influence of BMI on depth at each location was evaluated by simple linear regression analysis. Results The mean age was 43.2 years and mean BMI was 23.6 kg/m2. The depth from skin to the TPs or FJs was unaffected by age, sex, or side. Mean depths (cm) were as follows: (TPs) L1 = 4.5, L2 = 4.9, L3 = 5.3, L4 = 5.7, L5 = 5.9; (FJs) L12 = 3.8, L23 = 4.0, L34 = 4.4, L45 = 4.6, L5S1 = 4.6. Depth was highly correlated with BMI at each location. Conclusion The depth of TPs and FJs adjusted for BMI can safely and effectively be used for treatment via various invasive interventions, including acupotomy treatment, in the lumbar region.
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Affiliation(s)
- Sang-Hoon Yoon
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
| | - Shin-Ae Kim
- Chung-Yeon Korean Medicine Hospital, Gwangju, Republic of Korea
| | - Geon-Yeong Lee
- Chung-Yeon Korean Medicine Hospital, Gwangju, Republic of Korea
| | - Hyunho Kim
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jungtae Leem
- Chung-Yeon Central Institute, Gwangju, Republic of Korea.,Research Center of Traditional Korean Medicine, Wonkwang University, Iksan, Republic of Korea
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22
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Albano D, Messina C, Gambino A, Gurgitano M, Sciabica C, Oliveira Pavan GR, Gitto S, Sconfienza LM. Segmented lordotic angles to assess lumbosacral transitional vertebra on EOS. 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 2020; 29:2470-2476. [PMID: 32783082 DOI: 10.1007/s00586-020-06565-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/29/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To test the vertical posterior vertebral angles (VPVA) of the most caudal lumbar segments measured on EOS to identify and classify the lumbosacral transitional vertebra (LSTV). METHODS We reviewed the EOS examinations of 906 patients to measure the VPVA at the most caudal lumbar segment (cVPVA) and at the immediately proximal segment (pVPVA), with dVPVA being the result of their difference. Mann-Whitney, Chi-square, and ROC curve statistics were used. RESULTS 172/906 patients (19%) had LSTV (112 females, mean age: 43 ± 21 years), and 89/172 had type I LSTV (52%), 42/172 type II (24%), 33/172 type III (19%), and 8/172 type IV (5%). The cVPVA and dVPVA in non-articulated patients were significantly higher than those of patients with LSTV, patients with only accessory articulations, and patients with only bony fusion (all p < .001). The cVPVA and dVPVA in L5 sacralization were significantly higher than in S1 lumbarization (p < .001). The following optimal cutoff was found: cVPVA of 28.2° (AUC = 0.797) and dVPVA of 11.1° (AUC = 0.782) to identify LSTV; cVPVA of 28.2° (AUC = 0.665) and dVPVA of 8° (AUC = 0.718) to identify type II LSTV; cVPVA of 25.5° (AUC = 0.797) and dVPVA of - 7.5° (AUC = 0.831) to identify type III-IV LSTV; cVPVA of 20.4° (AUC = 0.693) and dVPVA of - 1.8° (AUC = 0.665) to differentiate type II from III-IV LSTV; cVPVA of 17.9° (AUC = 0.741) and dVPVA of - 4.5° (AUC = 0.774) to differentiate L5 sacralization from S1 lumbarization. CONCLUSION The cVPVA and dVPVA measured on EOS showed good diagnostic performance to identify LSTV, to correctly classify it, and to differentiate L5 sacralization from S1 lumbarization.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy. .,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milano, Italy
| | - Angelo Gambino
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | - Martina Gurgitano
- Divisione di Radiologia, IEO Istituto Europeo di Oncologia IRCCS, Via Ripamonti 435, 20141, Milano, Italy
| | - Carmelo Sciabica
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | | | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milano, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milano, Italy
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23
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Shah M, Halalmeh DR, Sandio A, Tubbs RS, Moisi MD. Anatomical Variations That Can Lead to Spine Surgery at The Wrong Level: Part II Thoracic Spine. Cureus 2020; 12:e8684. [PMID: 32699684 PMCID: PMC7370605 DOI: 10.7759/cureus.8684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Spine surgery at the wrong level is a detrimental ordeal for both surgeon and patient, and it falls under the wrong-site surgery sentinel events reporting system. While there are several methods designed to limit the incidence of these events, they continue to occur and can result in significant morbidity for the patient and malpractice lawsuits for the surgeon. In thoracic spine, numerous risk factors influence the development of this misadventure. These include anatomical variations such as transitional vertebrae, rib variants, hemivertebra, and block/fused vertebrae as well as patient characteristics, such as tumors, infections, previous thoracic spine surgery, obesity, and osteoporosis. An extensive literature search of the PubMed database up to 2019 was completed on each of the anatomical entities and their influence on developing thoracic spine surgery at the wrong level, taking into consideration patient’s individual factors. A reliable protocol and effective techniques were described to prevent this error. In addition, the surgeon should collaborate with radiologists, particularly in challenging cases. A thorough understanding of the surgical anatomy and its variants coupled with patients characteristic is crucial for maximal patient benefit and avoidance of thoracic spine surgery at the wrong level.
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Affiliation(s)
- Manan Shah
- Neurosurgery, Wayne State University, Detroit Medical Center, Detroit, USA
| | | | - Aubin Sandio
- Neurosurgery, Wayne State University, Detroit Medical Center, Detroit, USA
| | - R Shane Tubbs
- Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA.,Anatomical Sciences, St. George's University, St. George's, GRD.,Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
| | - Marc D Moisi
- Neurosurgery, Detroit Medical Center, Detroit, USA
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24
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Uldin H, McGlynn E, Cleasby M. Using the T11 vertebra to minimise the CT-KUB scan field. Br J Radiol 2020; 93:20190771. [PMID: 32208971 PMCID: PMC10993226 DOI: 10.1259/bjr.20190771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Computed tomography scans of the kidney, ureters, and bladder (CT-KUB) are crucial in investigating urinary calculi but impart a substantial radiation doses. Radiation can be limited by minimising the scanning field to the necessary area (i.e. from the kidneys to urethra). Before auditing, the superior limit of CT-KUB scans had not been formally clarified at our trust. Consistently ensuring the upper limit of scans is at or below T10 has been shown to be a viable method of performing CT-KUB scans. This study aimed to assess the overscan length of CT-KUB investigations and modify practice accordingly to minimise it. There were two standards that were set for CT-KUB scanning. First, the mean percentage overscan length (i.e. percentage of the scan above the kidneys) should be <15%. Second, all scans should include the superior borders of both kidneys. METHODS 90 consecutive CT-KUB scans for ureteric calculus were retrospectively investigated using IMPAX software in the first phase of data collection. After these data were analysed, a newly devised protocol using T11 as the superior scan limit was delivered to radiographers in the department. and 105 in the second phase (re-audit). The analysis parameters were: percentage overscan length, distance between diaphragm and upper border of kidneys, vertebral level at which the scan commenced, and whether both kidneys were fully included. RESULTS In the first phase, overscan of >15% was present in 94.4% of scans. The mean percentage overscan length was 28.2%. The superior vertebral limit of 59% of scans was at T10 or below and a lower superior vertebral limit correlated with decreasing overscan. 99% of scans fully included both kidneys. In the second phase (3 months later), the mean overscan percentage reduced to 10.6% (standard deviation = 4.4%). Excessive overscan affected 35.2% of scans. The superior vertebral limit of 8% of scans was at T10 or below. 100% of scans fully included both kidneys. CONCLUSION Excessive overscanning was due to inconsistent technique in capturing CT-KUB scans. Before this audit, the superior limit of CT-KUB scans had not been formally clarified at our trust. By successfully standardising the process with a reproducible method, the overscan target was comfortably met. Therefore, patient dose was minimised without compromising scan quality. ADVANCES IN KNOWLEDGE This audit has successfully shown a feasible standardised protocol for CT-KUB investigations which can be used to minimise overscanning of patients.
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Affiliation(s)
- Hasaam Uldin
- Heartlands, Good Hope, and Solihull Hospitals, University
Hospitals Birmingham NHS Foundation Trust,
Birmingham, United Kingdom
| | - Eunan McGlynn
- Heartlands, Good Hope, and Solihull Hospitals, University
Hospitals Birmingham NHS Foundation Trust,
Birmingham, United Kingdom
| | - Morgan Cleasby
- Heartlands, Good Hope, and Solihull Hospitals, University
Hospitals Birmingham NHS Foundation Trust,
Birmingham, United Kingdom
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Bergen TA, Mesropyan NA, Smagina AV. [Magnetic-resonance imaging under degenerative changes in lumbar spine: state of the art]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:104-112. [PMID: 31577276 DOI: 10.17116/neiro201983041104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) of lumbar spine is a very frequent examination in any computer tomography unit. However, there are still no scan standards or standards for scan interpretation in the world's medical community. In this article based on our experience we describe common problems encountered by a radiologist during MRI examination of lumbar spine and its subsequent description. The literature survey and analysis are presented with a summary of current recommendations. We examined routine sequences, which could be included in MRI protocol, discussed common terminology, and showed the incidence of different pathologies. The special emphasis is made on assessing lumbar canal stenosis. In this article we focus on qualitative and quantitative criteria of lumbar spinal stenosis.
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Affiliation(s)
| | | | - A V Smagina
- Federal State Budgetary Educational Institution of Higher Education Novosibirsk State Medical University of the RF Ministry of Health, Novosibirsk, Russia
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26
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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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Induced lumbosacral radicular symptom referral patterns: a descriptive study. Spine J 2019; 19:163-170. [PMID: 29800710 DOI: 10.1016/j.spinee.2018.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/10/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbosacral radicular symptoms are commonly evaluated in clinical practice. Level-specific diagnosis is crucial for management. Clinical decisions are often made by correlating a patient's symptom distribution and imaging with sensory dermatomal maps. It is common for patients to describe non-dermatomal symptom patterns and for imaging to demonstrate pathology at levels not predicted by a dermatomal map. These observations suggest that the referred symptom distribution from lumbosacral nerve root provocation is different from dermatomal maps. This phenomenon has been demonstrated in the cervical spine but not in the lumbosacral spine. PURPOSE The objective of this study was to characterize potential lumbosacral radicular symptom referral patterns induced during transforaminal epidural injections. STUDY DESIGN/SETTING This is an observational descriptive study. PATIENT SAMPLE The patient sample included 71 consecutive patients with lumbosacral radicular pain undergoing lumbosacral transforaminal epidural injections at an outpatient interventional spine practice. OUTCOME MEASURES Each subject drew the location of provoked lumbosacral radicular symptoms on a pain diagram. MATERIALS AND METHODS Seventy-one consecutive patients undergoing 125 fluoroscopically guided lumbosacral transforaminal epidural injections at an outpatient interventional spine practice were included in the study. The described location of provoked symptoms was recorded (1) after final needle positioning, (2) after injection of up to 0.5 mL of contrast solution, and (3) after injection of up to a 1 mL test dose of 1% lidocaine. Each subject drew the location of provoked symptoms on a diagram. The provoked symptom diagrams for each lumbosacral segmental level were combined to create composite nerve root, level-specific, symptom referral pattern maps. RESULTS Of the 125 injections, 87 provoked referred symptoms and were included in the analysis. Thirty-eight injections did not provoke referred pain symptoms and were excluded from further analysis. Four nerve roots were tested at L1 and eight were tested at L2. Because of the small number of subjects, composite diagrams and statistical analysis were not completed for these levels. Eleven nerve roots were analyzed at L3, 28 at L4, 34 at L5, and 11 at S1. Composite symptom referral pattern maps were created for levels L3, L4, L5, and S1. Although the symptom distribution occasionally followed the expected dermatomal maps, most often the referral was outside of the patterns expected for each level. The most common symptom referral pattern for levels L3-S1 was the buttock, the posterior thigh, and the posterior calf. CONCLUSIONS The level-specific provoked symptom distribution during lumbosacral transforaminal epidural injections is frequently different from that predicted by classic lumbosacral dermatomal maps. Referred pain to the buttock, the posterior thigh, or the posterior calf may come from L3, L4, L5, or S1 nerve root segmental irritation.
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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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29
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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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30
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Du Plessis AM. Author reply. J Anat 2018; 233:397-399. [PMID: 29877587 PMCID: PMC6081504 DOI: 10.1111/joa.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Anneli M Du Plessis
- Department Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
- Department of Biomedical Sciences, Division of Anatomy, Tygerberg Medical Campus, University of Stellenbosch, Stellenbosch, South Africa
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31
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Brocal J, De Decker S, José-López R, Manzanilla EG, Penderis J, Stalin C, Bertram S, Schoenebeck JJ, Rusbridge C, Fitzpatrick N, Gutierrez-Quintana R. C7 vertebra homeotic transformation in domestic dogs - are Pug dogs breaking mammalian evolutionary constraints? J Anat 2018; 233:255-265. [PMID: 29761492 DOI: 10.1111/joa.12822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 12/20/2022] Open
Abstract
The number of cervical vertebrae in mammals is almost constant at seven, regardless of their neck length, implying that there is selection against variation in this number. Homebox (Hox) genes are involved in this evolutionary mammalian conservation, and homeotic transformation of cervical into thoracic vertebrae (cervical ribs) is a common phenotypic abnormality when Hox gene expression is altered. This relatively benign phenotypic change can be associated with fatal traits in humans. Mutations in genes upstream of Hox, inbreeding and stressors during organogenesis can also cause cervical ribs. The aim of this study was to describe the prevalence of cervical ribs in a large group of domestic dogs of different breeds, and explore a possible relation with other congenital vertebral malformations (CVMs) in the breed with the highest prevalence of cervical ribs. By phenotyping we hoped to give clues as to the underlying genetic causes. Twenty computed tomography studies from at least two breeds belonging to each of the nine groups recognized by the Federation Cynologique Internationale, including all the brachycephalic 'screw-tailed' breeds that are known to be overrepresented for CVMs, were reviewed. The Pug dog was more affected by cervical ribs than any other breed (46%; P < 0.001), and was selected for further analysis. No association was found between the presence of cervical ribs and vertebral body formation defect, bifid spinous process, caudal articular process hypoplasia/aplasia and an abnormal sacrum, which may infer they have a different aetiopathogenesis. However, Pug dogs with cervical ribs were more likely to have a transitional thoraco-lumbar vertebra (P = 0.041) and a pre-sacral vertebral count of 26 (P < 0.001). Higher C7/T1 dorsal spinous processes ratios were associated with the presence of cervical ribs (P < 0.001), supporting this is a true homeotic transformation. Relaxation of the stabilizing selection has likely occurred, and the Pug dog appears to be a good naturally occurring model to further investigate the aetiology of cervical ribs, other congenital vertebral anomalies and numerical alterations.
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Affiliation(s)
- J Brocal
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S De Decker
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - R José-López
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - E G Manzanilla
- Teagasc Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - J Penderis
- Vet-Extra Neurology, Broadleys Veterinary Hospital, Stirling, UK
| | - C Stalin
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S Bertram
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - J J Schoenebeck
- Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - C Rusbridge
- Fitzpatrick Referrals, Eashing, Surrey, UK.,School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | | | - R Gutierrez-Quintana
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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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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Du Plessis AM, Greyling LM, Page BJ. Differentiation and classification of thoracolumbar transitional vertebrae. J Anat 2018; 232:850-856. [PMID: 29363131 DOI: 10.1111/joa.12781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 11/30/2022] Open
Abstract
The literature states that transitional vertebrae at any junction are characterized by features retained from two adjacent regions in the vertebral column. Currently, there is no published literature available that describes the prevalence or morphology of thoracolumbar transitional vertebrae (TLTV). The aim of this study was to identify the qualitative characteristics of transitional vertebrae at the thoracolumbar junction and establish a technique to differentiate the various subtypes that may be found. A selection of vertebral columns from skeletal remains (n = 35) were evaluated in this study. Vertebrae were taken based on features that are atypical for vertebrae in each relative region. The transitional vertebrae were qualitatively identified based on overlapping thoracic and lumbar features of vertebrae at the thoracolumbar junction. The following general overlapping characteristics were observed: aplasia or hypoplasia of the transverse process, irregular orientation on the superior articular process and atypical mammillary bodies. The results show that the most frequent location of the transitional vertebrae was in the thoracic region (f = 23). The second most frequent location was in the lumbar region (f = 10). In two specimens of the selection (f = 2), an additional 13th thoracic vertebra was present which functioned as a transitional vertebra. This study concluded that one can accurately identify the characteristics of transitional vertebrae at the thoracolumbar junction. In addition, the various subtypes can be differentiated according to the region in the vertebral column the vertebra is located in and the relative number of vertebral segments in the adjacent regions of the vertebral column. This provides a qualitative tool for researchers to differentiate the transitional vertebrae from distinctly different typical thoracic or lumbar vertebrae at the thoracolumbar junction.
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Affiliation(s)
- Anneli M Du Plessis
- Division of Anatomy, Department of Biomedical Sciences, University of Stellenbosch, Cape Town, South Africa.,Department Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Linda M Greyling
- Division of Anatomy, Department of Biomedical Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Benedict J Page
- Division of Anatomy, Department of Biomedical Sciences, University of Stellenbosch, Cape Town, South Africa
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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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Automatic detection of vertebral number abnormalities in body CT images. Int J Comput Assist Radiol Surg 2017; 12:719-732. [DOI: 10.1007/s11548-016-1516-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Adverse Fetal and Neonatal Outcome and an Abnormal Vertebral Pattern: A Systematic Review. Obstet Gynecol Surv 2016; 71:741-750. [DOI: 10.1097/ogx.0000000000000388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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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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Farshad-Amacker NA, Herzog RJ, Hughes AP, Aichmair A, Farshad M. Associations between lumbosacral transitional anatomy types and degeneration at the transitional and adjacent segments. Spine J 2015; 15:1210-6. [PMID: 24216396 DOI: 10.1016/j.spinee.2013.10.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 07/18/2013] [Accepted: 10/23/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The relation between specific types of lumbosacral transitional vertebra and the degree of degeneration at and adjacent to the transitional level is unclear. It is also unknown whether the adjacent cephalad segment to a transitional vertebra is prone to greater degeneration than a normal L5-S1 level. PURPOSE The purpose of this study was to evaluate the relation between specific lumbosacral transitional vertebra subtypes according to the Castellvi classification, and to determine the severity of degeneration at the transitional level and the adjacent cephalad segment. STUDY DESIGN This study was a retrospective review. PATIENT SAMPLES Ninety-two subjects with lumbosacral transitional vertebra grade 2 or higher and 94 control subjects without were retrieved from a picture archiving and communication system (PACS) search. OUTCOME MEASURES Disc degeneration parameters at the transitional and at the adjacent cephalad level were measured. METHODS After institutional review board approval, 92 subjects (42 men; mean age, 57±16 years) with lumbosacral transitional vertebra grade 2 or higher and 94 control subjects (41 men; mean age, 51±16 years) without were retrieved from a PACS search. Degeneration of the last two segments of the lumbar spine was quantified using the Pfirrmann and Modic classifications, along with documentation of annular tears, disc herniations, and disc height, and were compared between the two groups. Furthermore, L5-S1 levels in the control subjects were compared with the adjacent cephalad segments of the transitional vertebrae for the same parameters. RESULTS Although the control subjects, at L5-S1, had moderate to severe degeneration by Pfirrmann grades (31%) and Modic changes ([MC] 20%), in comparison, the discs at the transitional level of the lumbosacral transitional vertebra group demonstrated significant less degeneration (3% and 1%, respectively; each p<.05). The adjacent cephalad segments of the lumbosacral transitional vertebra group showed significantly greater degeneration (Pfirrmann grade 5, 39%; MC, 30%) compared with the L4-L5 level in control subjects (16% and 11%, respectively; each p<.05). The severity of disc degeneration using all parameters correlated with the type of lumbosacral transitional vertebra. The degree of degeneration of L5-S1 in control subjects was similar to the adjacent cephalad segment in lumbosacral transitional vertebrae. CONCLUSION Increasing the mechanical connection of a lumbosacral transitional vertebra protects the disc at the transitional level and predisposes the adjacent cephalad segment to greater degeneration. The adjacent cephalad segment had a comparable degree of degeneration as the L5-S1 level in control subjects.
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Affiliation(s)
- Nadja A Farshad-Amacker
- MRI Radiology Department, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA.
| | - Richard J Herzog
- Spinal Imaging, Radiology Department, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine and Scoliosis Service, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Alexander Aichmair
- Spine and Scoliosis Service, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Mazda Farshad
- Spine and Scoliosis Service, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
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Merits of different anatomical landmarks for correct numbering of the lumbar vertebrae in lumbosacral transitional anomalies. 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 2014; 24:600-8. [PMID: 25223429 DOI: 10.1007/s00586-014-3573-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Anatomical landmarks and their relation to the lumbar vertebrae are well described in subjects with normal spine anatomy, but not for subjects with lumbosacral transitional vertebra (LSTV), in whom correct numbering of the vertebrae is challenging and can lead to wrong-level treatment. The aim of this study was to quantify the value of different anatomical landmarks for correct identification of the lumbar vertebra level in subjects with LSTV. METHODS After IRB approval, 71 subjects (57 ± 17 years) with and 62 without LSTV (57 ± 17 years), all with imaging studies that allowed correct numbering of the lumbar vertebrae by counting down from C2 (n = 118) or T1 (n = 15) were included. Commonly used anatomical landmarks (ribs, aortic bifurcation (AB), right renal artery (RRA) and iliac crest height) were documented to determine the ability to correctly number the lumbar vertebrae. Further, a tangent to the top of the iliac crests was drawn on coronal MRI images by two blinded, independent readers and named the 'iliac crest tangent sign'. The sensitivity, specificity and the interreader agreement were calculated. RESULTS While the level of the AB and the RRA were found to be unreliable in correct numbering of the lumbar vertebrae in LSTV subjects, the iliac crest tangent sign had a sensitivity and specificity of 81 % and 64-88 %, respectively, with an interreader agreement of k = 0.75. CONCLUSION While anatomical landmarks are not always reliable, the 'iliac crest tangent sign' can be used without advanced knowledge in MRI to most accurately number the vertebrae in subjects with LSTV, if only a lumbar spine MRI is available.
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Farshad-Amacker NA, Lurie B, Herzog RJ, Farshad M. Is the iliolumbar ligament a reliable identifier of the L5 vertebra in lumbosacral transitional anomalies? Eur Radiol 2014; 24:2623-30. [PMID: 24962830 DOI: 10.1007/s00330-014-3277-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/21/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Sufficiently sized studies to determine the value of the iliolumbar ligament (ILL) as an identifier of the L5 vertebra in cases of a lumbosacral transitional vertebra (LSTV) are lacking. METHODS Seventy-one of 770 patients with LSTV (case group) and 62 of 611 subjects without LSTV with confirmed L5 level were included. Two independent radiologists using coronal MR images documented the level(s) of origin of the ILL. The interobserver agreement was analysed using weighted kappa/kappa (wκ/κ) and a Fischer's exact test to assess the value of the ILL as an identifier of the L5 vertebra. RESULTS The ILL identified the L5 vertebra by originating solely from L5 in 95 % of the controls; additional origins were observed in 5 %. In the case group, the ILL was able to identify the L5 vertebra by originating solely from L5 in 25-38 %. Partial origin from L5, including origins from other vertebra was observed in 39-59 % and no origin from L5 at all in 15-23 % (wκ = 0.69). Both readers agreed that an ILL was always present and its origin always involved the last lumbar vertebra. CONCLUSION The level of the origin of the ILL is unreliable for identification of the L5 vertebra in the setting of an LSTV or segmentation anomalies. KEY POINTS • The origin of the ILL is evaluated in subjects with an LSTV. • The origin of the ILL is anatomically highly variable in LSTV. • The ILL is not a reliable landmark of the L5 vertebra in LSTV.
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Affiliation(s)
- Nadja A Farshad-Amacker
- MRI, Radiology Department, Hospital for Special Surgery, 535 East 70th Street, New York, 10021, NY, USA,
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Tureli D, Ekinci G, Baltacioglu F. Is any landmark reliable in vertebral enumeration? A study of 3.0-Tesla lumbar MRI comparing skeletal, neural, and vascular markers. Clin Imaging 2014; 38:792-6. [PMID: 24928822 DOI: 10.1016/j.clinimag.2014.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 04/10/2014] [Accepted: 05/02/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to determine the reliability of the iliolumbar ligament (ILL), 12th costa, aortic bifurcation (AB), right renal artery (RRA), and conus medullaris (CM) for numbering of vertebral segments. SUBJECTS AND METHODS Five hundred five patients underwent routine lumbar MRI examinations including a cervicothoracic sagittal scout and T1 and T2-weighted sagittal and axial turbo spin echo images. Images were evaluated by two radiologists separately. RESULTS The identifiability of ILL and 12th costa were 85.7% and 48.1%. AB, RRA, and CM were located more caudally in lumbarized S1 and more cranially in sacralized L5 cases. CONCLUSION Landmarks suggested by previous studies are not reliable alternatives to cervicothoracic scout images due to wide ranges of distribution and inconsistencies in identification.
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Affiliation(s)
- Derya Tureli
- Marmara Univ. Pendik EAH, Radyoloji AD, Fevzi Cakmak Mahallesi Mimar Sinan Caddesi No: 41, 34899 Ust Kaynarca Pendik, Istanbul, Turkey.
| | - Gazanfer Ekinci
- Marmara Univ. Pendik EAH, Radyoloji AD, Fevzi Cakmak Mahallesi Mimar Sinan Caddesi No: 41, 34899 Ust Kaynarca Pendik, Istanbul, Turkey.
| | - Feyyaz Baltacioglu
- Marmara Univ. Pendik EAH, Radyoloji AD, Fevzi Cakmak Mahallesi Mimar Sinan Caddesi No: 41, 34899 Ust Kaynarca Pendik, Istanbul, Turkey.
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Tokgoz N, Ucar M, Erdogan AB, Kilic K, Ozcan C. Are spinal or paraspinal anatomic markers helpful for vertebral numbering and diagnosing lumbosacral transitional vertebrae? Korean J Radiol 2014; 15:258-66. [PMID: 24644411 PMCID: PMC3955794 DOI: 10.3348/kjr.2014.15.2.258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 12/13/2013] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. Materials and Methods Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. Results The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. Conclusion The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.
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Affiliation(s)
- Nil Tokgoz
- Department of Radiology, Gazi University School of Medicine, Ankara 06510, Turkey
| | - Murat Ucar
- Department of Radiology, Gazi University School of Medicine, Ankara 06510, Turkey
| | - Aylin Billur Erdogan
- Department of Radiology, Gazi University School of Medicine, Ankara 06510, Turkey
| | - Koray Kilic
- Department of Radiology, Gazi University School of Medicine, Ankara 06510, Turkey
| | - Cahide Ozcan
- Department of Radiology, Gazi University School of Medicine, Ankara 06510, Turkey
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Connor SEJ, Shah A, Latifoltojar H, Lung P. MRI-based anatomical landmarks for the identification of thoracic vertebral levels. Clin Radiol 2013; 68:1260-7. [DOI: 10.1016/j.crad.2013.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 01/20/2023]
Affiliation(s)
- S E J Connor
- Neuroradiology Department, King's College Hospital, London, UK.
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Nakajima A, Usui A, Hosokai Y, Kawasumi Y, Abiko K, Funayama M, Saito H. The prevalence of morphological changes in the thoracolumbar spine on whole-spine computed tomographic images. Insights Imaging 2013; 5:77-83. [PMID: 24052419 PMCID: PMC3948909 DOI: 10.1007/s13244-013-0286-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/21/2013] [Accepted: 08/26/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This article reviews the prevalence of lumbarisation, sacralisation and lumbar ribs, and their morphological relevance by evaluating multi-slice computed tomography (MSCT) images. These segment variations can cause miscounting of vertebrae at the lumbar spinal level. METHODS A retrospective radiographic analysis of 226 cases scanned by MSCT prior to forensic autopsy was undertaken. MSCT scans of the entire spine were obtained. Radiological data were evaluated on a three-dimensional image workstation. Vertebral levels were determined by counting downward from the first cervical vertebra, based on the assumption of seven cervical, 12 thoracic and five lumbar vertebrae. The prevalence of lumbarisation, sacralisation and lumbar ribs was assessed. RESULTS Lumbar ribs were observed in 13 of the 226 cases (5.8 %). Lumbarisation and sacralisation were observed in 14 cases (6.2 %) and six cases (2.7 %), respectively. Lumbar ribs were present in 11 of the 14 cases with lumbarisation, and in two of the 206 cases with normal lumbar vertebral configuration. Lumbarisation had a statistically significant association with lumbar ribs (p < 0.01). CONCLUSIONS There was a strong association between lumbar ribs and lumbarisation, with a resulting miscount rate for the lumbar spine of slightly less than 10 %. TEACHING POINTS • Lumbarisation and sacralisation are observed 6.2 % and 2.7 %, respectively. • Thoracolumbar segment variations can cause a miscount rate for the lumbar spine of less than 10 %. • Lumbar rib is significantly associated to lumbarisation.
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Affiliation(s)
- Aya Nakajima
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Sendai, 980-8575, Japan
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Cohen SP, Maus T, Kennedy D. The Need for Magnetic Resonance Imaging Before Epidural Corticosteroid Injection. PM R 2013; 5:230-7. [DOI: 10.1016/j.pmrj.2013.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 02/05/2013] [Indexed: 01/11/2023]
Affiliation(s)
- Steven P. Cohen
- Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Timothy Maus
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - D.J. Kennedy
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Pavilion C, MC 6342, Redwood City, CA 94063
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Thawait GK, Chhabra A, Carrino JA. Spine segmentation and enumeration and normal variants. Radiol Clin North Am 2012; 50:587-98. [PMID: 22643386 DOI: 10.1016/j.rcl.2012.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article provides a comprehensive review of spine segmentation and enumeration. This important and relatively underappreciated issue, when neglected, frequently results in confusion in vertebral numbering and ultimately may result in wrong segment interventions. The authors supplement this topic with a discussion of normal variants.
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Affiliation(s)
- Gaurav K Thawait
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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