Transverse sacralization of lumbar vertebrae: prevalence according to Castellvi classification

2016 ◽  
Vol 3 (1) ◽  
pp. 116
Author(s):  
Juhi V. Patel ◽  
Chetan M. Mehta ◽  
Nandakishore G. Patil ◽  
Shreya R. Sehgal
Keyword(s):  
Lumbar Vertebrae ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
The Body ◽  
Type I ◽  
Transitional Vertebra ◽  
Spinal Movement ◽  
Vertebral Disc ◽  
Fifth Lumbar Vertebra ◽  
Lumbosacral Transitional Vertebra

<p class="abstract"><strong>Background:</strong> Sacralization of L5 is a congenital anomaly, in which the lumbar vertebra, mainly its transverse process, gets fused or semi-fused with the sacrum or the ilium or to both. This fusion can occur in one or both sides of the body. Sacralization leads to fusion of the L5 (fifth lumbar vertebra) and S1 (first sacral vertebra) and the inter-vertebral disc between them may be narrow. Sacralization of lumbar vertebra may be asymptomatic but is not always clinically insignificant. While sacralization may not affect at all, it can cause problems in some cases. Sacralization may be at times associated with problems in biomechanics and affect the ways of movement and posture control. Sacralization may also be an important consideration in disc surgeries. This study has been carried out to find out prevalence of sacralisation of transverse process of fifth lumbar vertebrae<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> The present study of transverse sacralisation of fifth lumbar vertebra was carried out on 35 randomly selected patients. The sample consisted of patients undergoing CT scan for abdominal complains. Bone window of all patients were evaluated to look for lumbosacral transitional vertebra.<strong></strong></p><p class="abstract"><strong>Results:</strong> The prevalence of transverse sacralization of lumbar vertebra turned out to be 25.7% out of which Castellvi type IIb was found to be most common, accounting for 33.3% cases. 5.7% comprised the group of normal variant (Castellvi’s type I) and 68.6% were normal<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span>It is important to determine lumbosacral transitional vertebra as it can affect spinal movement and put excess stress on the lumbar vertebrae and in between disc. Moreover it</span> can have a bearing on counting of vertebral levels specially during planning of spinal surgey<span lang="EN-IN">.</span></p><p> </p>

scholarly journals LUMBOSACRAL TRANSITIONAL VERTEBRA ASSOCIATED WITH SACRAL SPINA BIFIDA OCCULTA: A CASE REPORT

2013 ◽  
Vol 56 (3) ◽  
pp. 126-129
Author(s):  
George Paraskevas ◽  
Maria Tzika ◽  
Panagiotis Kitsoulis
Keyword(s):  
Case Report ◽  
Spina Bifida ◽  
Lumbar Vertebra ◽  
Spina Bifida Occulta ◽  
Sacral Vertebra ◽  
Transitional Vertebra ◽  
Fifth Lumbar Vertebra ◽  
Lumbosacral Transitional Vertebra ◽  
Incomplete Closure ◽  
Lumbosacral Transitional Vertebrae

Congenital malformations such as lumbosacral transitional vertebrae and spina bifida occulta constitute unrare anomalies and could affect the symptomatology of low back pain. A transitional vertebra is characterized by elongation of one or both transverse processes, leading to the appearance of a sacralized fifth lumbar vertebra or a lumbarized first sacral vertebra. Furthermore, sacral spina bifida occulta is a developmental anomaly that corresponds to the incomplete closure of the vertebral column. In the present case report, we describe a case of a dried sacrum presenting a partially sacralized fifth lumbar vertebra and total spina bifida, extended from first to fifth sacral vertebra. A pseudoarthrosis is formed on the left side and the specimen could be incorporated in Castellvi’s type IIa. Moreover, the incidence, morphology, clinical and surgical significance of these spinal malformations are discussed.

Biometrical sexual differentiation of fourth, fifth and sixth lumbar vertebrae in blue bull (Boselaphus tragocamelus)

2018 ◽  
Author(s):  
S. Sathapathy ◽  
B.S. Dhote ◽  
D. Mahanta ◽  
S. Tamilselvan ◽  
M. Mrigesh ◽  
...  
Keyword(s):  
Average Length ◽  
Lumbar Vertebrae ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
Transverse Diameter ◽  
Average Height ◽  
Legal Cases ◽  
Vertebral Canal ◽  
Fifth Lumbar Vertebra ◽  
Wild Life

The present study was carried out on the lumbar vertebrae of adult Blue bull (Boselaphus tragocamelus) of either sex. Biometrical observations on different parameters of lumbar vertebrae reflected significance (P Less than 0.05) differences between the sexes of this species. It was confirmed that the average length of body gradually decreased from fourth to sixth lumbar vertebrae in the Blue bull. The average transverse diameter or width of vertebral canal and average vertical diameter or height of the vertebral canal was largest in the sixth lumbar vertebra. The average length of transverse process gradually increased from fourth to fifth lumbar vertebra and then it suddenly decreased in the sixth lumbar vertebra. The average height of the dorsal supraspinous process gradually decreased from fourth to sixth lumbar vertebrae and it was lowest in the sixth one. The data on the biometry of fourth, fifth and sixth lumbar vertebrae of Blue bull would develop a baseline that could be useful to the wild life Veterinarians in identification and solving vetero-legal cases.

scholarly journals Onyiuke Grading Scale: A Clinical Classification System for the Diagnosis and Management of Bertolotti Syndrome

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Joshua Knopf ◽  
Subin Lee ◽  
Ketan R Bulsara ◽  
Hilary C Onyiuke ◽  
David B Choi ◽  
...  
Keyword(s):  
Back Pain ◽  
Classification System ◽  
Lumbar Vertebrae ◽  
Rare Condition ◽  
Transverse Process ◽  
Clinical Classification ◽  
Transitional Vertebra ◽  
Italian Physician ◽  
Therapeutic Algorithm ◽  
Lumbosacral Transitional Vertebra

Abstract INTRODUCTION Lumbosacral transitional vertebrae (LSTV) is a common anatomic variant of the spine, characterized by the formation of a pseudoarticulation between the transverse process of the lumbar vertebrae and sacrum or ilium. The altered biomechanics and instability of the spine have been implicated as a potential source of low back pain dubbed Bertolotti Syndrome, named for the Italian physician who initially reported such a rare condition. Traditionally, lumbosacral transitional vertebra have been subdivided into types I-IV based on the Castellvi radiographic classification system.1 However, identifying the type of LSTV in this way fails to consider these findings within the clinical context and provides no clinical relevance to the treatment of Bertolotti Syndrome. METHODS Patients presenting with back pain between 2011 and 2018 attributable to a lumbosacral transitional vertebra were identified retrospectively. Data was collected from these patients' charts regarding demographic information, clinical presentation, diagnostic imaging, treatment, and outcomes. Based on evaluation of these cases and review of the literature, a diagnostic-therapeutic algorithm is proposed. RESULTS Based on our experiences evaluating and treating these patients and review of the existing literature, we propose a clinical classification system for Bertolotti Syndrome, we proposed a 4-grade scale for patients with Bertolotti syndrome based upon location, severity, and characteristics of pain experienced due to LSTVs. CONCLUSION Based on our experience with the cases illustrated here, we recommend managing patients with LSTV based on our diagnostic-therapeutic algorithm. Moving forward, a larger prospective study with a larger patient cohort is needed to further validate the treatment paradigm.

Bertolotti Syndrome

2016 ◽  
Author(s):  
Jiang Wu ◽  
Jianguo Cheng
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Compression Fracture ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
Lumbosacral Spine ◽  
Medial Branch ◽  
Low Back ◽  
Transitional Vertebra ◽  
Lumbosacral Transitional Vertebra

Bertolotti syndrome is caused by a lumbosacral transitional vertebra,  a congenital variation of the most caudal lumbar vertebra, characterized by an enlarged transverse process that articulates or fuses with the sacrum, ilium, or both. This syndrome accounts for 4.6 to 7% of cases of low back pain in adults and for more than 11% of patients with low back pain who are under 30 years old. The primary effect of lumbosacral transitional vertebra is reduced and asymmetrical motion between the transitional vertebra and the sacrum, resulting in early arthritic changes at pseudoarticulation; the secondary effect is the progressively compensatory modifications in the biomechanics of the mobile vertebral segments superior to the transitional vertebra related to restriction in rotation and bending motion at the lumbosacral articulation. Bertolotti syndrome should be considered in the differential diagnosis of low back pain. Clinical findings include low back pain in the midline or paramedian area that is reproduced with palpation along the base of the lumbosacral spine and near the posterosuperior iliac spine and aggravated by forward flexion, excessive extension, or lateralization of the back to the same side of the mega-apophysis. A plain x-ray is diagnostic; the extension-flexion lumbosacral radiographs in anteroposterior, lateral, and oblique views demonstrate lumbosacral transitional vertebra, with an enlarged unilateral or bilateral transverse process of the most distal lumbar vertebra, abnormally articulating with the ala of the sacrum and degenerative changes of the pseudarthrosis. Other imaging studies, such as computed tomography and magnetic resonance imaging of the lumbosacral spine and selective radiculography of the spinal nerve, could provide additional detailed anatomic information. Major differential diagnoses of Bertolotti syndrome include sacroiliac joint pain, myofascial pain, lumbar facet pain, lumbar disk herniation, compression fracture, and Baastrup disease/interspinous bursitis. These conditions are not mutually exclusive and, in fact, often coexist. A course of conservative management, including activity modification, medication management with nonsteroidal antiinflammatory drugs, muscle relaxants, and rehabilitative physical therapy, should be offered initially. Due to the multifactorial etiology of low back pain in patients with Bertolotti syndrome, procedures such as diagnostic intrapseudoarticular block for arthritis, medial branch block for facet arthropathy, diskography for diskogenic pain, and selective nerve roots block for radiculopathy can potentially help identify the primary and secondary origins of the pain. Surgical treatment of Bertolotti syndrome was only slightly better than conservative treatment and should only be used in very selective patients with disk pathology. To achieve long-term improvement by any of these therapeutic options, a continuing physical rehabilitation program is often needed. Key words: Bertolotti syndrome, intrapseudoarticular block, transitional lumbosacral vertebra, transverse process  

Association between lumbar sacralization and increased degree of vertebral slippage and disc degeneration in patients with L4 spondylolysis

2019 ◽  
Vol 30 (6) ◽  
pp. 767-771
Author(s):  
Xinqiang Yao ◽  
Ruoting Ding ◽  
Junhao Liu ◽  
Siyuan Zhu ◽  
Jingshen Zhuang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Disc Degeneration ◽  
Transverse Process ◽  
Modic Changes ◽  
Bony Fusion ◽  
Transitional Vertebra ◽  
Type Iiia ◽  
Type Iiib ◽  
Significant Difference ◽  
Lumbosacral Transitional Vertebra

OBJECTIVEThe aim of this study was to evaluate the effect of lumbar sacralization on the level of vertebral slip and disc degeneration in patients with L4 spondylolysis.METHODSThe authors analyzed data from 102 cases in which patients underwent surgical treatment for L4 spondylolysis and spondylolisthesis at their institution between March 2007 and September 2016. Lumbar sacralization was characterized by the presence of pseudarthrosis and/or bony fusion between the L5 transverse process and sacrum, and the type of lumbosacral transitional vertebra (LSTV) was evaluated with the Castellvi classification. The amount of vertebral slippage was measured using the Taillard technique and Meyerding grade. Degeneration of the L4–5 segment was quantified using the Pfirrmann and Modic classifications. Patients were divided into 2 groups based on the presence or absence of sacralization, and the amount of vertebral slip and degeneration of the L4–5 segment was compared between groups.RESULTSLumbar sacralization was present in 37 (36%) of 102 patients with L4 spondylolysis. The LSTV was type IIa in 10 cases, type IIb in 7, type IIIa in 2, and type IIIb in 18. The levels of vertebral slip and disc degeneration in the group of patients with sacralization were significantly greater than in the group without sacralization. No significant difference was found between the 2 groups with respect to Modic changes.CONCLUSIONSThe increased stability between a sacralized L5 and the sacrum may predispose the L4–5 segment to greater instability and disc degeneration in patients with L4 spondylolysis.

scholarly journals Primary acute purulent osteomyelitis of the spine. B. Hubrich (Zentralbl. F. Chir. 1929, No. 33)

1929 ◽  
Vol 25 (10) ◽  
pp. 1115-1115
Author(s):  
I. Tsimkhes
Keyword(s):  
Lumbar Vertebra ◽  
Transverse Process ◽  
The Body ◽  
Partial Damage

B. Hubrich (Zentralbl. F. Chir. 1929, No. 33) observed 2 cases of primary acute purulent osteomyelitis: in one case of the left transverse process and part of the body of the IV lumbar vertebra; in another case, partial damage to the body of the V lumbar vertebra was observed.

scholarly journals Traumatic Lumbosacral Dislocation Treated with Posterior Lumbar Interbody Fusion Using Intersomatic Cages

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Katsuhiro Tofuku ◽  
Hiroaki Koga ◽  
Kazunori Yone ◽  
Setsuro Komiya
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
Normal Activity ◽  
Fusion Rate ◽  
Radiographic Examination ◽  
Lumbar Interbody Fusion ◽  
Fifth Lumbar Vertebra ◽  
Lumbosacral Dislocation

A 35-year-old man was struck by a car on his right side and presented with paraparesis of both lower extremities. Radiographic examination revealed multiple transverse process fractures and anterior displacement of L5 on S1. Computed tomography revealed a bilateral anterior facet dislocation of the fifth lumbar vertebra on the sacrum. MRI showed rupture of the posterior ligamentous complex. A posterior lumbar interbody fusion using two intersomatic cages and pedicle screw instrumentation and posterior fusion were performed. Although no major disc lesion was found at the level of L5-S1 on preoperative MRI, a severely collapsed L5-S1 disc was found intraoperatively. Two years after surgery, the patient was asymptomatic with normal neurological findings, and has resumed normal activity. We believe that lumbosacral dislocation can be considered a three-column injury with an L5-S1 disc lesion, and, therefore, requires a solid circumferential segmental arthrodesis to improve fusion rate.

scholarly journals Steinmann Pins and Polymethylmethacrylate Repair of Fourth Lumbar Vertebral Fracture and Dorsocranial Luxation in PuppySteinmann Pins and Polymethylmethacrylate Repair of Fourth Lumbar Vertebral Fracture and Dorsocranial Luxation in Puppy

2020 ◽  
Vol 48 ◽  
Author(s):  
Fernando Bezerra Da Silva Sobrinho ◽  
Ivan Felismino Charas Dos Santos ◽  
Claudia Valéria Seullner Brandão ◽  
Sheila Canevese Rahal ◽  
César Passareli Cândido Lobo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Vertebral Fracture ◽  
Lumbar Vertebrae ◽  
Lumbar Vertebra ◽  
The Body ◽  
Labrador Retriever ◽  
Lumbar Vertebral Fracture ◽  
Cord Injury ◽  
Fourth Lumbar Vertebra

Background: Acute spinal traumas can lead to irreversible damage associated with vascular and inflammatory changes in neural tissue. Since spine and spinal cord traumas have an unfavorable prognosis in small animals, and reports of the use of Steinmann pins and polymethylmethacrylate repair of lumbar vertebra fracture-luxation in puppies are rare in the literature, the present paper aimed to report the surgical treatment of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment by using Steinmann pins and polymethylmethacrylate in a 7-month-old Labrador Retriever male dog.Case: A 7-month-old intact male Labrador Retriever dog, weighing 24.0 kg was attended at School Veterinary Hospital with a history of hit by car and paraplegia of the hind limbs. On neurological examination was observed no proprioception and no deep pain sensitivity on the both pelvic limbs. The lumbar spinal palpation showed intense pain, and the motor function and patellar reflexes were reduced. The values of haematological and biochemical analysis remained within the reference values for the species. Radiographs revealed a transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment, and was decided to perform a surgical treatment by open reduction and internal fixation of the fracture. The dog was positioned in ventral recumbency for surgery, and a dorsal midline incision was made from the second lumbar vertebra to the sixth lumbar vertebra. Two crossed 1.5 mm Kirschner wires were placed through the caudal articular facets of the fourth lumbar vertebra to provide initial stability. Two 2.0 mm Steinmann pins were placed at 60° angle of the bodies of the second and fifth lumbar vertebrae, and third and fourth lumbar vertebrae. This procedure was repeated on the other side of the vertebral bodies. Sixty grams of polymethylmethacrylate bone cement was applied and the fixation was checked for stability. Muscular, subcutaneous tissue and skin was closed routinely. The dog was paraplegic without any pain and used a wheelchair to assist in locomotion, although it still had urinary and faecal incontinence; no tail control; and the implants were not removed.Discussion: Lumbar vertebral injuries, as in the present case frequently, occur secondary to severe trauma (e.g. hit by car) and seem to have a characteristic fracture pattern. The patient became paraplegic due to spinal cord injury and failure of sensitivity and elimination of urine and feces which can be associated with progressive destruction of neuronal tissue due to secondary vascular and inflammatory events. The radiographic exam was used to confirm the spinal injury and determine whether by conservative or surgical treatment. The treatment choice is related to the number of fractured compartments, and the presence or not of compression. Fractures in two or more compartments are indicative of surgical treatment, similar as the present case. Use of Steinmann pins was to make a rigid fixing system compared with block plates used for the same function. Use of polymethylmethacrylate may also become a complication due to the infection, for this reason was prescribed an antibiotic for 15 days. This procedure proved to be effective since the dog showed no signs of infection. According to the characteristics of the present case report, the use of Steinmann pins and polymethylmethacrylate for repair of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment provided an effective and practical means of stabilisation, promoting decompression, and thus, improving the patient's quality of life.

scholarly journals Lumbar plain radiograph is not reliable to identify lumbosacral transitional vertebra types according to Castellvi Classification principle

2020 ◽  
Author(s):  
Lisheng Hou ◽  
Xuedong Bai ◽  
Haifeng Li ◽  
Tianjun Gao ◽  
Wei Li ◽  
...  
Keyword(s):  
Plain Radiograph ◽  
Transverse Process ◽  
Bony Union ◽  
Transitional Vertebra ◽  
Type Iiia ◽  
Final Study ◽  
Lumbosacral Transitional Vertebra ◽  
Anteroposterior View ◽  
Type Classification ◽  
Real Type

Abstract Background: The anteroposterior view of lumbar plain radiograph (AP-LPR) was chosen as the original and first radiographic tool to determine and classify lumbosacral transitional vertebra with morphological abnormality (MA-LSTV) according to Castellvi Classification. However, recent studies found that AP-LPR might not sufficient to detect or classify MA-LSTV correctly. The present study aims to verify the reliability of AP-LPR on detecting and classifying MA-LSTV types, taking coronal reconstructed CT images (CT-CRIs) as gold criteria. Methods : Patients with suspected MA-LSTVs determined by AP-LPR were initially enrolled. Among them, those who received CT-CRIs were formally enrolled to verify the sensitivity of AP-LPR on detecting and classifying MA-LSTV types according to Castellvi classification principle. Results : 298 cases were initially enrolled as suspected MA-LSTV ones, among whom 91 cases who received CT-CRIs were enrolled into the final study group. All suspected MA-LSTVs were verified to be real MA-LSTV ones by CT-CRIs. However, 35.2% of the suspected MA-LSTVs types judged by AP –LPR were not consistent with final types judged by CT-CRIs. Two suspected type IIIa and 20 suspected IIIb ones were verified to be true, while 9 of 39 suspected IIa, 9 and 3 of 17 suspected IIb , and 11 of 13 suspected IV ones were verified to be real type IIIa, IIIb, IV and IIIb ones by CT-CRIs, respectively. Incomplete joint-like structure (JLS) or bony union structure (BUS), and remnants of sclerotic band (RSB) between the transverse process (TP) and sacrum were considered to be the main reasons for misclassification. Conclusion : Although AP-LPR could detect MA-LSTV correctly, it could not give accurate type classification. CT-CRIs could provide detailed information between the TP and sacrum area, and could be taken as gold standard to detect and classify MA-LSTV.

Radiographic Assessment of Anatomic Deviatoins in Lumbar Spondylolysis

1984 ◽  
Vol 25 (4) ◽  
pp. 317-323 ◽  
Author(s):  
H. Saraste ◽  
L.-Å. Broström ◽  
T. Aparisi
Keyword(s):  
Lumbar Vertebrae ◽  
Lumbar Vertebra ◽  
Control Group ◽  
Disc Space ◽  
Lumbar Spondylolysis ◽  
Fifth Lumbar Vertebra ◽  
The Difference ◽  
Lumbosacral Lordosis ◽  
Spine Disorders ◽  
And Control

A series of 202 patients (133 men, 69 women) with spondylolysis were examined with respect to radiographic variables describing lumbosacral lordosis, size of lumbar vertebrae, transverse processes and disc height. An age-standardized and sex-stratified comparison was made with a control group of 170 subjects (68 men, 102 women) without lumbar spine disorders. The difference in ***lumbosacral lordosis between the spondylolysis and control groups was considered to be secondary to olisthesis, and to lack an etiologic role for the genesis of lysis. The lengths of the transverse processes and their distances to the crista iliaca posterior demonstrated no differences between the groups and therefore did not seem relevant to the context of the pathogenesis of spondylolysis. The fifth lumbar vertebra in the spondylolytic patients was more wedged and less wide than in the controls. The question of the primary or secondary nature of this change has not yet been clearly elucidated, and should be given further attention. The spondylolytic patients demonstrated a decrease in the height of the L5-S1 disc much earlier than the controls, and the degree of narrowing of the disc space was much more marked.

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