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Lumbosacral transitional vertebra associated with sacral spina bifida occulta: a case report

Authors:
Paraskevas George
Paraskevas George
Paraskevas George
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Maria Tzika at Aristotle University of Thessaloniki
Maria Tzika
Panagiotis Kitsoulis at University of Ioannina
Panagiotis Kitsoulis
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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 ofa 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.
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Lumbosacral transitional vertebra associated with sacral spina bifida occulta: a case repo
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... SBO is caused by failure of fusion between posterior vertebral elements without affecting the spinal cord or meninges, with a prevalence of 0.6-25% [21,22]. Although no definitive causal link has been established between congenital SBO and the development of lumbar disc herniation [23,24], SBO is suspected to be a predisposing factor for degenerative disc disease based on the hypothesis that congenital defects may cause instability of the base of the lumbar spine, therefore leading to degenerative deformities and posterior disc herniation [23]. LSTV is a congenital spinal anomaly defined as either sacralization or lumbarization [24]. ...
... SBO is caused by failure of fusion between posterior vertebral elements without affecting the spinal cord or meninges, with a prevalence of 0.6-25% [21,22]. Although no definitive causal link has been established between congenital SBO and the development of lumbar disc herniation [23,24], SBO is suspected to be a predisposing factor for degenerative disc disease based on the hypothesis that congenital defects may cause instability of the base of the lumbar spine, therefore leading to degenerative deformities and posterior disc herniation [23]. LSTV is a congenital spinal anomaly defined as either sacralization or lumbarization [24]. ...
... LSTV is common in the general population, with a reported prevalence of 4-30% [24]. Several reports indicate that a higher incidence of degenerative disc herniation and nerve root canal stenosis are encountered at a level above the LSTV due to increased mechanical stress and spine instability [22][23][24]. An association between LSTV and SBO was found in 0.02% of the healthy population [23]. ...
Successful annuloplasty using the cone-beam computed tomography-assisted radiofrequency thermocoagulation system in a patient with severe vertebral deformity: a case report
Article
Full-text available
  • Aug 2022
Background Complex anatomical features are challenging for minimally invasive intradiscal therapy owing to insufficient visualization for accurate needle advancement. We report the case of a patient with dysraphic vertebral pathologies who presented with L5/S1 degeneration and was successfully treated with annuloplasty using the cone-beam computed tomography (CBCT)-assisted radiofrequency thermocoagulation system. Case presentation A 34-year-old woman presented with a lower back and left radicular pain of L5/S1 discogenic origin, accompanied by spina bifida occulta and lumbosacral transitional vertebra. Radiofrequency annuloplasty was performed to preserve disc height and spinal stability, with real-time CBCT guidance for the congenital and degenerative conditions. The procedure relieved her left lower-extremity pain and magnetic resonance imaging revealed that the L5/S1 disc bulging decreased while the disc height was preserved. Conclusion Optimal accessibility of radiofrequency thermocoagulation and effective needle guidance using CBCT significantly improve the success rate of annuloplasty at the L5/S1 degenerative disc with severe vertebral deformity.
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... Several studies have reported cases of defects in the spine that are randomly simultaneous, labelling them as an 'association' [36][37][38]. For example a case report published by George et al. [37] associated a single case of spina bifida occulta to LSTV. ...
... Several studies have reported cases of defects in the spine that are randomly simultaneous, labelling them as an 'association' [36][37][38]. For example a case report published by George et al. [37] associated a single case of spina bifida occulta to LSTV. The data from those studies, however, do not support an association between the defects, but rather a chance of overlap. ...
Congenital malformations in the vertebral column: associations and possible embryologic origins
Article
Full-text available
  • Jul 2022
  • Anat Cell Biol
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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... Of these, two individuals exhibited SBO with LSTV (0.2 %). George et al. [55] reported on LSTV with SSBO observed on a dry bone sacrum of a Caucasian ("White") male and highlighted the importance of awareness of this anomaly. Sharma et al. [56] observed a higher prevalence of the co-existence of SBO and LSTV in patients suffering from LBP. SBO is a more frequent anomaly observed in the lumbosacral region of the vertebral column, as noted by Li et al. [57], with a 61.49 ...
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... Основным клиническим симптомом коморбидного течения этих аномалий у детей является болевой синдром [40,41], выраженность которого по визуальной аналоговой шкале обычно соответствует 3 баллам [16], но в редких случаях может достигать и 8-балльного значения [42]. Взаимоотягощающее влияние переходных позвонков и spina bifida posterior является фактором высокой степени риска формирования дегенерации межпозвонковых дисков, вплоть до стадии их секвестрации [43]. ...
Lumbosacral transitional vertebrae in children and adolescents (literature review, illustrated with clinical observations)
Article
  • Apr 2024
Introduction An analysis of the medical literature devoted to various aspects of transitional lumbosacral vertebrae shows that there are very few publications covering the course of this disease in the pediatric and adolescent population. Aim To study the issues of epidemiology, diagnosis, treatment and prevention of transitional lumbosacral vertebrae in paediatric and adolescent patients based on the analysis of current medical literature and illustrate the material with our own clinical observations. Material and methods To analyze the literature on the topic, 75 papers published between 1984 and 2023 were selected. Among them, there were 7 (9.3 %) domestic literary sources, 68 (90.7 %) were foreign. In the process of searching for scientific articles, the resources of the electronic databases of current medical information PubMed and CyberLeninka were used. Results and discussion The incidence of transitional vertebrae in children and adolescents is 16.8 % of clinical observations, as reported. In the structure of the transitional vertebrae in children, type II of the disease predominates according to the classification Castellvi et al (1984), 43.2 % of cases. The main clinical symptom of the pathology is pain of lumbosacral location, the intensity of which on the visual analog scale in children corresponds to an average of 3.0 points. In adult patients with similar pathology, the average pain intensity measured with the same scale is 7.5 points. The most informative method for diagnosing the disease is computed tomography, which allows obtaining both 3D images and sections at the level of pseudarthrosis between the enlarged transverse process (or processes) of the suprasacral vertebra and the wing of the sacrum. To relieve pain in children with transitional vertebrae, both conservative and surgical methods are used. The most commonly used procedure is pseudarthrectomy. The study of long-term results one year after the intervention allowed us to record the absence of pain in children who underwent surgery. Prevention measures for transitional lumbosacral vertebrae have not been developed. Conclusion The analysis of the published literature shows that transitional vertebrae are a frequently diagnosed pathology in children and adolescents. Current methods of imaging are able to accurately detect not only the presence of the disease, but also to differentiate its type. The main clinical symptom of transitional vertebrae is pain in the lumbosacral spine which is difficult to relieve with conservative therapy. Pseudarthrectomy is the most frequent surgical method of treatment in children and adolescents that provides stable relief of vertebrogenic pain syndrome. Measures for specific prevention of the disease have not been developed.
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... Среди аномалий развития пояснично-крестцовой локализации люмбализация позвонка S I наиболее часто сочетается с незаращением задней части дуги поясничных и крестцовых позвонков -spina bifida posterior [36,37]. Нередко взаимоотягощающее влияние этих двух патологических состояний клинически проявляется у пациентов не только болевым синдромом, но и неврологической симптоматикой различной степени выраженности [38]. ...
Transitional lumbosacral vertebrae
Article
  • Nov 2022
Transitional lumbosacral vertebrae in the form of SI lumbarization and LV sacralization are classified as spinal anomalies. In the domestic medical literature, there are few publications devoted to these pathological conditions. In the course of a study of the available literature on the problem of transitional lumbosacral vertebrae, it was found that the frequency of cases of transitional lumbosacral vertebrae diagnosis ranges from 4 to 30% of clinical cases. The share of patients with lumbar vertebrae accounts for an average of 40% of cases, the share of patients with sacralization of the vertebrae is 60% of clinical observations. Mutations in the Hox gene are considered to be the trigger for the development of pathology, and pain is usually the leading clinical symptom. Plain radiography, computed tomography and magnetic resonance imaging are used to diagnose the pathology. Radiation imaging of the entire spine is required to eliminate errors in vertebrae counting. The type of pathology is determined using various classifications. As conservative therapeutic agents, drug blockades applying anesthetics and hormonal drugs are used. The arsenal of surgical interventions includes resection of the enlarged transverse process of the supracacral vertebra, decompression of stenotic intervertebral foramina, impulsive radiofrequency ablation, and posterior fusion. Measures for the prevention of pathology are not currently developed.
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... Bennett 1972;Shinde & Bhusaraddi 2014;Sushanth & Shishirkumar 2014), others recognize all open shapes on dorsal sacrum as spina bifida occulta (e.g. Henneberg & Henneberg 1999;Ortner 2003;Albrecht et al. 2007;Senoglu et al. 2008;George et al. 2013;Singh 2013;Ali et al. 2014). ...
Sacral spina bifida occulta rare occurrence in Byzantine Belentepe population in Muğla, Turkey: A possible case for adequate folic acid intake
Article
  • Mar 2020
  • HOMO
Spina bifida may occur during the first weeks after conception; folic acid deficiency is strongly related to this anomaly. We argue that the low prevalence rate of spina bifida may indicate a relatively good nutrition state of a population, given that folic acid is found in many food products commonly eaten. The aim of this study is to examine the relationship between folic acid intake and spina bifida occulta prevalence in the Belentepe Byzantine population in Anatolian peninsula, and to compare the prevalence rates with various other ancient Anatolian populations by focusing on sacral spina bifida occulta in the Byzantine population. A total of 62 available human sacra were included in the study and compared with other sacra from relevant research using chi-squared test. Four male individuals had sacral spina bifida occulta with a prevalence rate of 6.45%, which is found to be lower in comparison to other ancient populations from western to eastern Anatolia. The present-day ecology of Belentepe indicates that foods rich with folic acid are common in and around the region. While some studies indicate the contrary, a comparison regarding the sacral spina bifida occulta prevalence with other populations in Anatolia shows a correlation between folic acid intake and proximity to a Mediterranean climate.
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... Kapalı spina bifida türlerinden biri olan sacral spina bifida occulta (SSBO), omurilik ve meninksleri etkilemeden posterior vertebral elemanlar arasındaki kaynaşma yetersizliği sebebiyle oluşur [6,14] Literatürde SSBO'lu kabul edilen sakrumların açıklık dereceleri farklılık gösterdiği için [3,5,17], karmaşaya yol açmamak adına bu çalışmada yalnızca posterior bölgeleri tamamen açık (S1 -S5) olan sakrumlar değerlendirmeye katılmıştır. ...
Milas Belentepe Doğu Roma – Bizans Toplumunda spina bifida occulta İnsidansı
Poster
Full-text available
  • Nov 2015
Amaç: Spina bifida, vertebral arkın bir kısmının ya da tamamının kapanmaması durumudur. Bu çalışmada; Milas Belentepe Doğu Roma - Bizans toplumunda görülen ve bir spina bifida türü olan sacral spina bifida occulta (SBO) patolojisi incelenmiştir. Bu inceleme sonucunda belirlenen bu patolojik olgunun ilgili toplumda görülme sıklığı belirlenerek, daha önce çalışılmış olan Kyzikos toplumu ve Doğu Anadolu’daki güncel bir çalışma ile karşılaştırılmıştır. Bu çalışmadaki amacımız, SBO’nun Anadolu’nun farklı iki bölgesindeki indisansını karşılaştırmak ve bu patolojinin muhtemel sebeplerine değinmektir. Gereç-Yöntem: Bu çalışmada, Milas Belentepe alanında 2011-2013 kazı sezonu boyunca ortaya çıkarılmış Doğu Roma Bizans dönemine ait 158 bireyin sakrumları yıkanıp kurutulduktan sonra incelenmiş ve bu bireylerin epifizleri tamamen kaynaşmış olanları değerlendirmeye katılmıştır. Yani yalnızca genç erişkin/erişkin bireylerin sakrumları değerlendirmeye tâbi tutulmuştur, bu yüzden 72 birey çalışılmıştır. Bireylerin yaşları ve cinsiyetleri iskeletin korunma durumuna göre, mevcut antropolojik yöntemlerden en uygun olanları seçilerek belirlenmiştir. Bulgular: İncelenen 72 sakrumun sadece iki tanesinde SBO patolojisine rastlanmıştır. BLT11-M116 numaralı ve BLT13-M90 numaralı bu iki birey de erişkin erkek olarak belirlenmiştir. Buna göre bu patolojik olgunun popülasyon içerisinde bulunma sıklığı %2,77’dir. Sonuç: SBO’nun etiyolojisi kesin olarak bilinmemekle birlikte, oluşumunda genetik ve çevresel etmenlerin birlikte rol aldığı, bu konuyla ilgili yapılan güncel araştırmalarda rapor edilmektedir. Konuyla ilgili yapılan araştırmalarda SBO’nun, gebeliğin ilk haftalarında oluştuğu ve folik asit (vitamin B9) eksikliğinin bu hastalığa neden olduğu literatürde açıkça ortaya konulmuştur. Folik asit, bitkisel ve hayvansal besinlerin birçoğunda bulunmaktadır. Çalışma kapsamındaki 72 bireyde yapılan değerlendirmede ortaya çıkan insidansın %2,77 gibi düşük bir oran olmasının sebebi, folik asit alımının, dolayısıyla beslenmenin bu toplumda nispeten iyi olmasından kaynaklanabilir. Çünkü bölgenin coğrafi yapısı gereği, folik asit açısından zengin ürünlerin bulunduğu bilinmektedir. Bir yandan bebek ve çocuk nüfusunun çalışmaya katılmaması da düşük insidansın sebelerinden biri olarak gösterilebilir. SBO’nun iki erişkin bireydeki varlığı, bize bu patolojinin genetik bir alt yapısının da olduğunu ve toplum içinde bu sebepten görülebildiğini düşündürmektedir. Kyzikos toplumunda 21 bireyin sadece ikisinde (%9,52) SBO görülmüştür. Bu bağlamda Belentepe toplumundaki SBO insidansının, Kyzikos'a göre çok daha düşük görünmesine rağmen, birey sayısındaki farklılığın buna sebep olduğu düşünülmektedir. Ayrıca Anadolu’da yapılan spina bifida (SB) çalışmalarında, bu insidansın Kuzey ve Doğu bölgelerinde, Batı bölgesine göre daha yüksek görülmesi, folik asit alımı ile SBO arasındaki ilişkiyi destekleyecek niteliktedir.
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Patologías congénitas y defectos del desarrollo en poblaciones arqueológicas en la costa desértica de Antofagasta: reflexiones sobre su origen a partir de casos de estudio
Article
Full-text available
  • May 2023
En este trabajo se presenta una síntesis y discusión sobre la presencia de patologías congénitas y defectos del desarrollo en individuos de diferentes periodos arqueológicos de la costa de la región de Antofagasta, en el norte de Chile, las que se concentran en el esqueleto axial. A pesar de que la muestra analizada presenta un número bajo (n = 6), se realiza una comparación con casos reportados para la zona costera de Arica y Tarapacá, obteniéndose que la diferencia entre ambas zonas no es estadísticamente significativa. Considerando antecedentes ambientales y etnohistóricos de la zona, se propone que una combinación a la exposición de diferentes contaminantes naturales, junto a un sistema de parentesco endogámico, serían las causas más probables de la aparición de estas patologías.
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Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change
Article
Full-text available
  • Jul 2022
Substantial relaxation of natural selection beginning around 1900 changed the mutation/selec­tion balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sa­cral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta lit­erature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence. A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequen­cy increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with impor­tant implications for the fields of biological anthropology and bioarchaeology.
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Incidence and patterns of lumbosacral transitional vertebrae, in patients with low backpain in a Nigerian hospital
Article
Full-text available
  • Apr 2009
  • Niger Q J Hosp Med
Lumbosacral transitional vertebrae (LSTV), is a structural anomaly, of the lumbosacral spine which has been variably associated with, low back pain (LBP) and its presence can also result in a level being wrongly identified pre-operatively. To determine the incidence, pattern of LSTV and its relationship with LBP in our tertiary hospital. A retrospective review of lumbosacral spine radiographs of 561 one consecutive patients with history of LBP was done from January 2006 to January 2008. The presence or absence of LSTV and degenerative changes were documented. Fifty-one ((9.1%)) out of 561 patients had LSTV. Type II (incomplete) LSTV was the commonest type, occurring in 86.3% of patient with LSTV. Patients less than 30yrs with LBP and LSTV had no degenerative changes, while all patients with LSTV above 50 yrs had degenerative changes. Lumbosacral transitional vertebrae type II was the commonest seen in this study, furthermore, LSTV appears to be a causative factor of LBP in young individuals. Careful evaluation of spinal radiographs of patients with LBP belonging to this group is advocated to assess for the presence or absence of LSTV.
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Lumbosacral transitional vertebra causing Bertolotti’s syndrome: a case report and review of the literature
Article
Full-text available
  • Jul 2009
Lumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium. The association of that variant with low back pain and the change in the biomechanical properties of the lumbar spine is called Bertolotti's syndrome. We report a case of a 40-year-old male patient with chronic low back pain extending to the left buttock, just above the ipsilateral sacroiliac joint. Radiographic investigation revealed an anomalous enlargement of the left transverse process of the fifth lumbar vertebra forming a pseudarthrosis with the infrajacent ala of the sacrum. In young patients with back pain the possibility of Bertolotti's syndrome should always be taken in account.
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Evaluation of Congenital Lumbosacral Malformations and Neurological Findings in Patients with Low Back Pain
Article
Full-text available
  • May 2009
  • TURK NEUROSURG
To investigate the correlation of congenital lumbosacral abnormalities with neurological signs in young patients with low back pain (LBP) MATERIAL AND METHODS: The study included 401 patients with LBP that lasted longer than 2 weeks. All cases were screened by standard lumbosacral x-rays for the presence of the most common congenital vertebral abnormalities i.e. spina bifida occulta (SBO) and transitional vertebra (TV). Patients were divided into two groups according to presence of a neurological sign. Patients with a neurological sign were referred for computerized tomography and/or magnetic resonance imaging. Sixty-two patients had a neurological sign. Congenital vertebral abnormalities were detected in 52 patients (12.1%); 34 of these (8.5%) were spina bifida, whereas 18 (4.5%) were transitional vertebra. SBO was most commonly observed at the S1 level (30 patients). No correlation for SBO or TV was determined in patients with and without neurological signs but these groups showed significant difference for disc herniation in CT or MRI (P=0.001). Congenital abnormalities had no correlation with disc herniation in CT or MRI. LBP in young adults with TV or SBO showed no correlation with neurological signs. Therefore patients with prolonged LBP that present with neurological signs may be scheduled for CT and/or MRI, but reevaluation of the patient with psychometric tests is recommended if there is no neurological sign.
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Radiological abnormalities of the lumbosacral spine in young male individuals
Article
  • Nov 2002
The purpose of this study was to determine the overall incidence and distribution of lumbosacral congenital abnormalities in healthy and active young male individuals. The study population consisted of 503 healthy young male candidates for sports training. Lumbosacral transitional vertebral (LSTV) Anormalities were found in 37 (7.4%) of subjects and were unilateral in 14 (2.8%) subjects (lumbarization/sacralization). Lumbar rotoscoliosis (LRS) was present in 14 (2.8%) subjects and facet asymmetry in one subject. LSTV and LRS together were present in 3 subjects. Spina Bifida Occulta (SBO) was present in 107 of 503 candidates (21.4%). The distribution of SBO throughout vertebra levels was as follows: 86 only in S1, 11 in S1+S2, 9 in L5, 1 in L5+S1. SBO and LSTV were present together in 8 subjects. SBO and LRS were present together in three subjects. 356 (70.4%) subjects had normal lumbosacral radiographs. Our study results support the notion that SBO is a common lumbosacral abnormality especially in young male healthy individuals.
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Causal Connection of Non-Specific Low Back Pain and Disc Degeneration in Children with Transitional Vertebra and/or Spina bifida occulta: Role of Magnetic Resonance - Prospective Study
Article
  • Jun 2012
The problem of low back pain (LBP) in children is very common and many specialists are dealing with it in everyday practice. The cause for low back pain often is not found and classified under the diagnosis of non specific low back pain. The objective of this prospective study is to determine wether children with non specific low back pain and existence of anomalies in LS spine (transitional vertebra- TV and/or Spina bifida occulta SBO) also have the degeneration of the intervertebral disc (DD) L4-L5 and/or L5-S1. This prospective study included 69 patients from 8 to 16 years of age (X 12.81) of whom 40 were male (57.97%), and 29 female (42.03%). They all were examinated in University of Zagreb, "Sestre milosrdnice" University Hospital Center, Zagreb Children's Hospital, Department of Orthopaedic, Zagreb, Croatia. The reason of their visit was non specific low back pain. Pain was measured by visual analog scale (VAS) and mean score was three, duration of pain was between two and four weeks. Also, pain was sporadic, during daytime and not connected with level of physical activity. They all have undergone an algorithm of radiological examinations. Standard AP and LL radiographs (RTG) were made, as well as magnetic resonance (MR) of LS spine and sacrum in sagittal and transversal plane in T1 and T2 weighted sequence. The anomalies of L5 and S1 were found in 65 patients: transitional vertebra classified according to Castellvi et al. and SBO. In MRI in T2 weighted sequence DD was found in 61 patients which was classified modified from Pearce. Data analysis and comparison showed that 56patients with TV and/or SBO have changes on vertebral dynamic segment L5-S1 (VDS) and that means DD. In 13 patients only DD or spinal anomaly (TV and/or SBO) were found. Correlation between anomalies and DD in those patients was established by McNemar analysis and has shown significant difference (p=0.581) in favour of the patients with anomaly and DD. This has established that all of 56 patients with spinal anomaly could have DD as known cause of LBP.
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The prevalence of transitional vertebrae in the lumbar spine
Article
  • Sep 2011
Lumbosacral transitional vertebrae (LSTVs) are a congenital vertebral anomaly of the L5-S1 junction in the spine. This alteration may contribute to incorrect identification of a vertebral segment, leading to wrong-level spine surgery and poor correlation with clinical symptoms. Although several studies describe the occurrence of this anomaly in back pain populations, investigation of the prevalence in the American general population is lacking. To establish the prevalence rates for LSTVs in the general population. Retrospective review. Consecutive kidney-urinary bladder (KUB) radiographs of subjects from the past 2 years (2008-2009). Clinical demographics, number of lumbar vertebrae, L5-S1 transverse process (TP) height, and rib length. Consecutive adult KUB studies of adult subjects were queried with clear visibility of the last rib's vertebral body articulation, all lumbar TPs, and complete sacral wings. Exclusion criteria consisted of any radiologic evidence of previous lumbosacral surgery that would obstruct our measurements. A total of 1,100 abdominal films were reviewed, and 211 were identified as being adequate for the measurement of the desired parameters. Two hundred eleven subjects were identified as eligible for the study, and 75 (35.6%) were classified as positive for a transitional lumbosacral vertebra. The most common anatomical variant was the Castellvi Type IA (14.7%). The average age at the time of the KUB study was 59.8 years (18-95 years). One hundred ninety-seven subjects (93.4%) presented five lumbar (nonribbed) vertebrae, and only 14 (6.6%) had six lumbar vertebrae. The significance of lumbosacral transitional level changes to the establishment of pain, degenerative changes, stenosis, and disc disease have been well documented in symptomatic patients. Although LSTV's role in low back pain remains controversial, our study has shown that, when the same criteria are used for classification, prevalence among the general population and symptomatic patients may be similar.
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Prevalence of Sacral Spina Bifida Occulta and Its Relationship to Age, Sex, Race, and the Sacral Table Angle An Anatomic, Osteologic Study of Three Thousand One Hundred Specimens
Article
  • Aug 2009
  • SPINE
An anatomic, osteologic study of spina bifida occulta (SBO). To determine the prevalence and patterns of SBO in a large population and examine its relationship to age, sex, and race; then to evaluate SBOs relationship to the sacral table angle (STA) when compared with an age-matched control group. SBO has a reported prevalence of 1.2% to 50% and has been implicated in various pathologic problems. SBO is often associated with spondylolysis or spondylolithesis. The STA has been implicated as an etiologic or predictive factor in the presence of pars defects. Three thousand one hundred osteologic specimens were evaluated for the presence of SBO. SBO was graded on a scale from 0 to III. Information on the age, sex, race, and STA of each specimen was recorded and measured, respectively. Prevalence and patterns of SBO were enumerated. The STAs of an age-matched control group of 355 specimens were examined. The SBO group and control groups were compared in regards to STA, controlling for age, sex, and race. Overall, 355 specimens displayed SBO, for an overall prevalence of 12.4%. Of the SBO specimens, 68.7% were white, 88.2% were men, 53% were grade I, 37% II, and 10% III. All 3 grades of SBO were more common in men than women (88.2% vs. 11.8%) and more prevalent in whites than blacks (68.7% vs. 31.3%) (P = 0.01). SBO decreased in prevalence with increasing age. The average STA in SBO specimens was 95.9 degrees . This differed from an age-matched control group, 92.1 degrees (P < 0.0001). Every 1 degrees increase in STA resulted in a 6% increased likelihood of SBO. In SBO specimens, the STA decreased with increasing age, contrary to age-matched controls. SBO has an overall prevalence of 12.4% in a large, diverse population. SBO is more common in men and whites and decreases in prevalence with increasing age. The STA is greater in SBO when compared with controls and an increased STA predicts SBO. In SBO, the STA decreases with increasing age.
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Bertolotti??s Syndrome Revisited: Transitional Vertebrae of the Lumbar Spine
Article
  • Jan 1990
Bertolotti's syndrome refers to the association of back pain with lumbosacral transitional vertebrae. Such vertebrae were observed in 140 of 2,000 adults with back pain over a 4-year period of study. Each patient had radiographic evaluation of the lumbar spine by plain films as well as a sectional imaging modality (magnetic resonance [MR] or computed tomography [CT]). The overall incidence of structural pathology (eg, spinal stenosis and disc protrusion) detected by CT or MR was not apparently higher in patients with transitional vertebrae, but the distribution of these lesions was significantly different. Disc bulge or herniation, when it occurred, was nearly nine times more common at the interspace immediately above the transitional vertebra than at any other level. Spinal stenosis and nerve root canal stenosis were more common at or near the interspace above the transitional vertebra than at any other level. Degenerative change at the articulation between the transverse process of the transitional vertebra and the pelvis was an uncommon occurrence; when seen there was no significant correlation with the reported side of pain. It is postulated that hypermobility and altered stresses become concentrated in the spine at the level immediately above a lumbar transitional vertebra. Accelerated disc and facet joint degeneration at this level may then result.
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Relation between the low back pain syndrome and X-ray findings. III. Spina bifida occulta
Article
  • Feb 1980
  • Scand J Rehabil Med
The relation between LBP and SBO was studied in 1244 subjects, of which 800 had LBP and 444 served as controls. Sex, age, occupational characteristics, spine curvatures, spinal movements and work history were compared. It is concluded that SBO does not play a causative role, does not cause a proneness to LBP and does not influence the chronicity of LBP. Some data seem to indicate that the severity of LBP may be increased by SBO.
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