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 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.

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 Iv ◽  
Type Iiia ◽  
Final Study ◽  
Lumbosacral Transitional Vertebra ◽  
Anteroposterior View ◽  
Type Classification

Abstract Background: The anteroposterior view of the 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 the Castellvi classification. However, recent studies found that AP-LPR might not be 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 the 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 the Castellvi classification principle. Results: A total of 298 cases were initially enrolled as suspected MA-LSTV, among which 91 cases who received CT-CRIs were enrolled into the final study group. All suspected MA-LSTVs were verified to be real MA-LSTVs by CT-CRIs. However, 35.2% of the suspected MA-LSTV types judged by AP-LPR were not consistent with the final types judged by CT-CRIs. Two suspected type IIIa and 20 suspected type IIIb MA-LSTVs were verified to be true, while 9 of 39 suspected type IIa, 9 and 3 of 17 suspected type IIb, and 11 of 13 suspected type IV MA-LSTVs were verified to truly be type IIIa, IIIb, IV and IIIb MA-LSTVs 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 correctly detect MA-LSTV, it could not give accurate type classification. CT-CRIs could provide detailed information between the TP and sacrum area and could be taken as the gold standard to detect and classify MA-LSTV.

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 RETROSPECTIVE DATA REVIEW TO FIND THE ASSOCIATION OF LUMBOSACRAL TRANSITIONAL VERTEBRA AND DEGENERATIVE DISC DISEASE IN YOUNG PATIENTS

2020 ◽  
Vol 70 (6) ◽  
pp. 1734-39
Author(s):  
Nadia Gul ◽  
Khalid Mehmood ◽  
Muhammad Ikram
Keyword(s):  
Disc Degeneration ◽  
Degenerative Disc Disease ◽  
Lumbar Disc ◽  
Statistical Significance ◽  
Young Patients ◽  
P Value ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Transitional Vertebra ◽  
Lumbosacral Transitional Vertebra

Objective: To find out the frequency of lumbar disc degeneration among the patients having lumbosacraltransitional vertebra between 20-40 years. Study Design: Retrospective cross sectional study. Place and Duration of Study: Radiology department POF Wah Cantt, from Jan 2018 to Dec 2019. Methodology: Six Hundred patients between 20-40 years having lumbosacral transitional vertebra and historyof low back pain >1 year were studied. X ray and MRI lumbar spine of these patients was studied retrospectivelyon PACS. Two hundred patients having history of traumatic or other non-traumatic etiologies, in addition toLumbosacral transitional vertebra were excluded. Four hundred patients with only lumbosacral transitionalvertebra were included. Data analysis was done by SPSS-22. Castellvi types of transitional vertebra was calculated among patients with degenerative lumbar disc. Results: One hundred and four (26.6%) were having degenerative disc disease while 296 (74.4%) patients werenot having degenerative disc disease. Patients having degenerative disc disease were between 24-40 years withthe mean age 29.96 ± 0.417 years. Among the patients having degenerative disc disease were 59 women and45 males but no statistical significance association was found between gender and degenerative disc disease with p-value = 0.55. Castellvi type III had significant association with degenerative disc disease, p-value = 0.006. Conclusion: Age related disc degeneration is commonly seen in middle age people but in younger age group in2nd and 3rd decade it is observed frequently in those patients having lumbosacral transitional vertebra especially in the setting of no other associated traumatic or non-traumatic etiology, which leads to early degenerative disc disease.

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  

scholarly journals Segmented lordotic angles to assess lumbosacral transitional vertebra on EOS

2020 ◽  
Vol 29 (10) ◽  
pp. 2470-2476 ◽  
Author(s):  
Domenico Albano ◽  
Carmelo Messina ◽  
Angelo Gambino ◽  
Martina Gurgitano ◽  
Carmelo Sciabica ◽  
...  
Keyword(s):  
Type I ◽  
Type Ii ◽  
Optimal Cutoff ◽  
Chi Square ◽  
Type Iii ◽  
Bony Fusion ◽  
Transitional Vertebra ◽  
Type Iv ◽  
Lumbar Segment ◽  
Lumbosacral Transitional Vertebra

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.

scholarly journals Role of iliac crest tangent in correct numbering of lumbosacral transitional vertebrae

2019 ◽  
Author(s):  
NESRİN GÜNDÜZ ◽  
GÜLÇİN DURUKAN ◽  
MEHMET BİŞLGİN ESER ◽  
AHMET ASLAN ◽  
ADNAN KABAALİOĞLU
Keyword(s):  
Computed Tomography ◽  
Disc Degeneration ◽  
Vertebral Body ◽  
Intervertebral Disc Degeneration ◽  
Iliac Crest ◽  
Observer Agreement ◽  
Transitional Vertebra ◽  
Lumbosacral Transitional Vertebra ◽  
Lumbosacral Transitional Vertebrae

Background and aim: 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 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 one third 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 as L5. The gold standard was counting the vertebrae craniocaudally. Results: The inter-observer agreement was good for determining ICT level (Cohen’s kappa=0.78, p<0.001). The rate of correct numbering by ICT in LSTV group was significantly lesser than controls (43.1% vs 96.4%, respectively, p<0.001). Patients with sacralization had significantly less correct numbering rate than 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. Key words: computed tomography, iliac crest tangent, lumbosacral transitional vertebra

scholarly journals Surgical Treatment of Vulvar HSIL: Adjuvant HPV Vaccine Reduces Recurrent Disease

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 83
Author(s):  
Alessandro Ghelardi ◽  
Roberto Marrai ◽  
Giorgio Bogani ◽  
Francesco Sopracordevole ◽  
Paola Bay ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hpv Vaccine ◽  
Recurrent Disease ◽  
Current Knowledge ◽  
Hpv Vaccination ◽  
Clinical Effectiveness ◽  
Hpv Infection ◽  
Control Group ◽  
Hpv Test ◽  
Significant Difference

Data suggest that adjuvant human papillomavirus (HPV)-vaccination in women treated for cervical HPV diseases reduces recurrent disease. This study investigates adjuvant HPV-vaccination and the rate of recurrence in women undergoing surgery for vulvar high-grade squamous intraepithelial lesions (HSIL). From January 2013 to April 2020, we enrolled 149 women in a prospective case-control study. The control group (NV-group) was treated by standard surgery alone, while the study group received adjuvant vaccination soon after surgery (V-group). A follow-up was performed by vulvoscopy and HPV test. Statistical analysis was performed by Fisher’s exact test. HSIL recurrence was observed in 24/76 (32%) patients in NV-group and in 8/42 patients (19%) of the vaccinated group. By analysing the recurrence rate related to the incident and reactivated latent HPV infection, we found a significant difference between (17/76) 22.3% in NV-group and (2/42) 4.8% in V-group (p = 0.01). A reduction of 78.5% in incident/reactivated HPV infections was demonstrated. Data results add to the current knowledge about the mechanism of post-surgical adjuvant HPV vaccination. Our prospective study is the first to document the vaccine clinical effectiveness in preventing “reactivation” of latent HPV infections. Quadrivalent HPV vaccine administered after the surgical treatment for vulvar HSIL appears to be useful in preventing recurrent disease.

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