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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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Bhagchandani C, Murugan C, Jakkepally S, Shetty AP, Kanna RM, Rajasekaran S. A Whole Spine MRI Based Study of the Prevalence, Associated Disc Degeneration and Anatomical Correlations of Lumbosacral Transitional Vertebra. Global Spine J 2023:21925682231161559. [PMID: 36867110 DOI: 10.1177/21925682231161559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Lumbosacral transitional vertebra (LSTV) results in numerical alterations of the lumbar and sacral segments. Literature concerning true prevalence, associated disc degeneration, and variation in numerous anatomical landmarks concerning LSTV is lacking. METHODS This is a retrospective cohort study. The prevalence of LSTV was determined in whole spine MRIs of 2011 poly-trauma patients. LSTV was identified as sacralization (LSTV-S) or lumbarization (LSTV-L) and further sub-classified into Castellvi's and O'Driscoll's type respectively. Disc degeneration was evaluated using Pfirmann grading. Variation in important anatomical landmarks was also analysed. RESULTS Prevalence of LSTV was 11.6% with 82% having LSTV-S. Castellvi's type 2A and O'Driscoll type 4 were the commonest sub-types. LSTV patients demonstrated considerably advanced disc degeneration. The median termination level of conus medullaris (TLCM) in non- LSTV and LSTV-L groups was at middle L1 (48.1% and 40.2%) while in the LSTV-S group, it was at upper L1 (47.2%). The median level of right renal artery (RRA) in non- LSTV patients was at middle L1 in 40.0% of individuals while in the LSTV-L and LSTV-S groups, it was at upper L1 level in 35.2% and 56.2% respectively. The median level of abdominal aortic bifurcation (AA) in non-LSTV and LSTV-S patients was at middle L4 in 83.3% and 52.04% respectively. However, in the LSTV-L group, the most common level was middle L5 (53.6%). CONCLUSION The overall prevalence of LSTV was 11.6%, with sacralization accounting for more than 80%. LSTV is associated with disc degeneration and a variation in the levels of important anatomical landmarks.
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Affiliation(s)
| | - Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
| | - Sridhar Jakkepally
- Department of Spine Surgery, Gandhi Medical College and Hospital, Secunderabad, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
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Cawley D, Shafafy R, Agu O, Molloy S. Anterior spinal fusion (ALIF/OLIF/LLIF) with lumbosacral transitional vertebra: A systematic review and proposed treatment algorithm. BRAIN & SPINE 2023; 3:101713. [PMID: 38021000 PMCID: PMC10668067 DOI: 10.1016/j.bas.2023.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 12/01/2023]
Abstract
•Key anterior approaches differences in LSTV include vascular (aortic bifurcation/iliocaval confluence), muscular (psoas) and osseus anatomy (inter-crestal tangent/pubic symphysis), when compared to non-LSTV.•There are increased surgical deviations but not significantly greater complications for anterior approaches in LSTV.•Vascular awareness while accessing L45 will be in the presence of a more cephalad ABF and ICC with sacralized L5, and access to the deeper L56 level will be in the presence of a more caudal ABF and ICC in lumbarized S1.
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Affiliation(s)
- D.T. Cawley
- Mater Private Hospital, Dublin, Republic of Ireland
- National University of Ireland, Galway, Republic of Ireland
| | - R. Shafafy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - O. Agu
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - S. Molloy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
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Caetano AP, Mascarenhas VV, Machado PM. Axial Spondyloarthritis: Mimics and Pitfalls of Imaging Assessment. Front Med (Lausanne) 2021; 8:658538. [PMID: 33968964 PMCID: PMC8100693 DOI: 10.3389/fmed.2021.658538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/11/2021] [Indexed: 01/15/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that predominantly involves the axial skeleton. Imaging findings of axSpA can be divided into active changes, which include bone marrow edema, synovitis, enthesitis, capsulitis, and intra-articular effusion, and structural changes, which include erosions, sclerosis, bone fatty infiltration, fat deposition in an erosion cavity, and bone bridging or ankylosis. The ability to distinguish between imaging lesions suggestive of axSpA and artifacts or lesions suggestive of other disorders is critical for the accurate diagnosis of axSpA. Diagnosis may be challenging, particularly in early-stage disease and magnetic resonance imaging (MRI) plays a key role in the detection of subtle or inflammatory changes. MRI also allows the detection of structural changes in the subchondral bone marrow that are not visible on conventional radiography and is of prognostic and monitoring value. However, bone structural changes are more accurately depicted using computed tomography. Conventional radiography, on the other hand, has limitations, but it is easily accessible and may provide insight on gross changes as well as rule out other pathological features of the axial skeleton. This review outlines the imaging evaluation of axSpA with a focus on imaging mimics and potential pitfalls when assessing the axial skeleton.
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Affiliation(s)
- António Proença Caetano
- Radiology Department, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Grupo Luz Saúde, Radiology Department, Imaging Center, Hospital da Luz, Lisbon, Portugal.,EpiDoC Unit, Chronic Diseases Research Centre, NOVA Medical School, Lisbon, Portugal
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom.,Department of Rheumatology, London North West University Healthcare National Health Service Trust, London, United Kingdom
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Lee JH, Lee KJ, Ki M, Kim M, Doo AR, Son JS. The abnormality of the number of ribs misleading incorrect vertebral segment identification during lumbar intervention - Two cases report -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.3.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jun Ho Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ki-Jae Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Minjong Ki
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Myungjong Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - A Ram Doo
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ji-Seon Son
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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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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