Are Transitional Vertebra and Spina Bifida Occulta Related with Lumbar Disc Herniation and Clinical Parameters in Young Patients with Chronic Low Back Pain?

[Main clinical characteristics of pain in patients with lumbosacral transitional vertebrae]

OBJECTIVE

Based on an analysis of modern medical literature, to study the main clinical characteristics of pain in patients with transitional lumbosacral vertebrae.

MATERIAL AND METHODS

A search was made for articles in the scientific electronic libraries CYBERLENINKA, eLIBRARY, Google Scholar, and the electronic database of biomedical publications PubMed. Sixty-eight scientific publications corresponded to the stated goal.

RESULTS

The review of literature shows that the localization of pain in patients with transitional vertebrae corresponds to the zone of pseudarthrosis between the enlarged transverse process of the LV vertebra and the wing of the sacrum. In most patients, the pain is deep, not superficial. Pain intensity ranges from 3.0 to 8.4, reaching an average of 6.0 on the visual analog scale. Pain can radiate to one of the buttocks and the lower limb. The intensity of pain in the leg at the same time, on average, reaches 5.4 points. The pain syndrome can last for months, the course of the disease acquires a sluggish, undulating character with periodic exacerbations. The causes of exacerbations of pain may be excessive loads on the spine, concomitant vertebrogenic diseases and spinal injuries, excess weight, and in women, a history of pregnancy. Pain management can be either conservative or surgical. The scope of conservative treatment consists of using acupuncture and taking non-steroidal anti-inflammatory drugs. The greatest therapeutic effect is achieved with local injection therapy of analgesics and glucocorticoids at the neoarticulation point. The effectiveness of the course of therapeutic blockades reaches a period from several months to a year. The arsenal of surgical techniques includes pseudoartrectomy, radiofrequency denervation, minimally invasive endoscopic surgery, and transpedicular fusion. In most patients, after surgical treatment, complete relief of pain is noted.

CONCLUSION

The review provides information on the predominant localization of pain in patients with transitional vertebrae, its nature, intensity, irradiation, duration, causes of exacerbation, as well as the effectiveness of the methods of conservative and surgical treatment.

Is lumbosacral transitional vertebra associated with lumbar disc herniation in patients with low back pain?

PURPOSE

To evaluate lumbosacral transitional vertebrae (LSTV) frequency in patients with low back pain and lumbar disc herniation (LDH) and to analyze correlations between LSTV presence and intervertebral disc degeneration.

METHODS

This retrospective study included patients with low back pain applying between January 2021 and August 2021. Inclusion criteria were age of 18-65, presence of a standing lumbosacral Xray and a lumbar MRI taken within 2 weeks of the indexed symptoms. Patients with a history of spondylolisthesis, spondylodiscitis, scoliosis and vertebral neoplasia were excluded. A total of 1821 patients met the inclusion criteria. Radiographs and MRIs were evaluated by 2 radiologists.

RESULTS

Of all patients, 61.4% were female and the mean age was 43.2 ± 12.2. LDH was detected in 57.7% of patients while a LSTV was present in 43.3%. Sacralization and LSTV were significantly different between the patients with and without an LDH. Patients with LSTV had a higher incidence of a LDH affecting 3 or more intervertebral disc levels (p < 0.001). There was a significant difference in-between LSTV and non-LSTV groups regarding the M1 and M2 intervertebral disc degeneration levels.

CONCLUSION

A LDH is more common in the presence of a LSTV. Female sex is highly correlated with herniation. Three or more intervertebral disc levels are affected in the presence of an LSTV. Significantly higher degeneration incurs at the M1 and M2 intervertebral levels. Sacralization is a risk factors for a lumbar disc herniation.

The incidence of congenital lumbosacral malformations in young male Turkish military school candidates population

BACKGROUND

During routine radiological examinations of the lumbar spine, congenital anomalies such as lumbosacral transition vertebra and scoliosis are frequently encountered in asymptomatic patients. They are not always associated with pathologies but have the potential to cause back pain in later times. The aim of this study is to analyze the prevalence of lumbar vertebral abnormalities in a group of young military school candidates who had no prior complaints.

METHODS

We retrospectively evaluated the direct radiographs of asymptomatic young men aged between 17 and 22 applying between July 2018 and August 2018, for the routine check-up before becoming military school students. Exclusion criteria were prior history of low back pain for any reason, sciatica, neurogenic claudication, history of prior spinal surgery and history of a concomitant rheumatologic disease. All radiographs were evaluated for total lumbar vertebra number, morphology, presence of lumbosacral transitional vertebrae (LSTV), spina bifida occulta (SBO) and presence of lumbar and/or lumbar-elongated scoliosis.

RESULTS

All 3132 patients were male and mean age was 18.37. Out of them, 887 (28.3%) had a congenital lumbo-sacral anomaly that they were not aware of. The most common anomaly we detected was SBO, in 16.2% of the cases followed by LSTV with 12.9% of the cases. Some of the applicants had more than one anomaly in their X-rays.

CONCLUSION

Correct identification of a lumbar abnormalities is of great importance, especially before surgical procedures. It is a known fact that most wrong-level spine surgery occurs in patients with variant spine anatomy, including LSTV. Meticulous screening and analyses should be performed to all patients scheduled for spinal surgery in order to avoid peri-operative complications and unwanted final results.

Neuromuscular scoliosis in the presence of spina bifida occulta and a transitional lumbosacral vertebra: A case report

Common and minor birth defects, such as spina bifida occulta (SBO) and lumbosacral transitional vertebra (LSTV), are largely asymptomatic and overlooked. However, it is important for clinicians to consider their potential impacts on spinal stability. Neuromuscular scoliosis (NMS) is an abnormal lateral curvature of the spine that affects children with pre-existing neuromuscular conditions that are often complex to manage. The purpose of this case report is to describe the association of dual lumbosacral anomalies with complicated NMS. A 12-year-old boy was brought to the chiropractor by his mother for a consultation and possible care for the boy's back pain, progressive scoliosis, and long-standing walking abnormality that worsened quickly in the past 12 months. His mother stated that the patient walked on the balls of his left foot instead of putting weight on the heel ever since he started learning to walk. He had visited several pediatricians and neurologists since childhood. No one had been able to solve his problems. Radiographs showed right thoracolumbar curve of Cobb angle 20°, left pelvic obliquity, a cleft in the L5 and S1, and articulation of the transverse processes of L5 with the bilateral sacral alae. The patient was diagnosed with NMS and functional leg length discrepancy attributed to SBO and a LSTV at L5 level. Multimodal chiropractic care and foot orthotics were used. After 18 months of interventions, normal spinal curve, heel-to-toe gait, and posture balance were retrieved successfully. To date, few reports have been published on the impacts of SBO along with LSTV upon the lumbosacral spine. This article will allow a better understanding of the potential impacts of these birth defects and considerable consequences they would have on the growing spine and, therefore, may help to alleviate their impacts.

The effect of transitional vertebrae and spina bifida occulta on disc herniation, disc degeneration, and end-plate changes in pediatric patients with low back pain

The aim of the study is to investigate the assumption whether lumbosacral transitional vertebrae (LSTV) and spina bifida occulta (SBO) cause lumbar disc herniation (LDH), intervertebral disc degeneration (IDD), and vertebral endplate changes / Modic changes (MCs) in children and adolescents with low back pain (LBP). Four hundred patients (aged 10-17) with LBP persisting for at least six weeks were included in the study. Lumbosacral X-rays were examined for the presence of LSTV and SBO. The prevalence of IDD/MCs and LDH at L4-5 and L5-S1 levels were investigated by evaluating the lumbosacral MRI of the patients with and without LSTV-SBO. The study population consisted of 219 girls and 181 boys with mean age 14.9±1.9. LSTV was determined in 67 (16.8%) patients and SBO in 62 (15.5%). No significant difference was observed in the prevalence of IDD, MCs, and LDH in patients with and without LSTV/SBO. LSTV and SBO were not observed in approximately 80% of patients without LDH and IDD/MCs. The presence of LSTV and SBO does not appear to represent a risk factor for early degeneration in lumbar spine and LDH in children and adolescents with LBP.

Axial Spondyloarthritis: Mimics and Pitfalls of Imaging Assessment

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.

Repair of lumbar vertebral bone defects by bone particles combined with hUC-MSCs in weaned rabbit

Aim: The major symptom of many closed spinal dysraphism patients is that the laminas or arches of vertebra are not fused well. To date, the bone repair of spina bifida for young children is a significant challenge in clinical practice. Materials & methods: Bovine bone collagen particle (BBCP) scaffolds combined with human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) were implanted in the defect area. X-ray analysis was performed after 3 months. Tissues were harvested for gross observation, and histological and immunohistochemical staining. Results: The BBCP supported hUC-MSCs adhesion and growth. Implanted BBCP combined with hUC-MSCs also promoted bone regeneration in the vertebral lamina and arch defect area. Conclusion: This method represents a new strategy for vertebral lamina and arch reconstruction in children.

Does Neuropathic Pain Affect the Quality of Sleep?

OBJECTIVE

We aimed to evaluate the quality of sleep (QoS) in patients with neuropathic pain (NP) and to investigate the association between possible QoS impairment and NP characteristics.

MATERIALS AND METHODS

Patients with NP and controls were examined. Age, sex, NP duration, NP cause (central, peripheral, or mixed), and pain intensity (with a Likert-type scale and visual analog scale) were recorded. NP was screened with Douleur Neuropathique 4 questions (DN4), and QoS was evaluated using the Pittsburg Sleep Quality Index (PSQI). Mann-Whitney U test and regression analysis were performed to evaluate the data.

RESULTS

Seventy patients with NP and 30 age- and sex-matched controls were included. The mean age of the patients and controls were 45.04±10.21 years and 39.00±19.23 years, respectively. Significantly higher scores of sleep latency (p=0.002), sleep duration (p=0.003), sleep efficiency (p=0.002), sleep disturbance (p<0.000), daytime dysfunction (p=0.04), and PSQI total were observed in patients with NP than in controls (p<0.000). In addition, 80% of patients with NP and 37 % of controls were classified as having poor QoS (p<0.000). Female sex, pain intensity, and NP duration were found to be factors related to having poor QoS in patients with NP (p=0.026, p=0.006, and p<0.000, respectively).

CONCLUSION

In our study, 80% of patients with NP had poor QoS regardless of the NP cause. Female sex, pain severity, and NP duration were found to be factors correlated with poor QoS. Treatment strategies that target not only NP itself but also better QoS may contribute to the overall success of management.

Transitional Vertebra and Spina Bifida Occulta Related with Chronic Low Back Pain in a Young Patient

Bertolotti’s syndrome (BS) must be considered as a differential diagnosis in a young patient presenting with low back pain (LBP). We present a case of a 26-year-old male complaining of mild chronic LBP for six years, radiating to his left thigh for the past six months. He has been taking non-steroidal anti-inflammatory drugs (NSAIDs) with skeletal muscle relaxants for pain relief. The X-ray and computed tomography (CT) imagings showed congenital enlargement of the left transverse process of the fifth lumbar (L5) vertebra forming pseudo-articulation with the sacrum and unilateral pars interarticularis defect at the L4 level on the left side, respectively. He has managed with gabapentin 100 mg three times a day for his neuropathic left leg pain. On follow-up, the patient reported that his pain has improved with gabapentin and it decreased from 8/10 to 4/10 on the visual analogue scale.