Symptomatic and morphometric analysis of lumbosacral transitional vertebrae: assessments by age and gender

Abstract

Aim: Lumbosakral transitional vertebrae (LSTV) are anatomical variations where a vertebra exhibits characteristics of both lumbar and sacral vertebrae. This study aims to assess anatomical changes in LSTV patients by measuring intervertebral disc height (IVDh), vertebral foramen anteroposterior diameter (FVAPd), and intervertebral foramen height (FIVh), with consideration of age and gender differences. Material and Methods: This retrospective study included 274 patients diagnosed with LSTV. All MRI images were acquired with a 1.5T MRI machine and a 32-channel lumbar coil. The presence of LSTV, forming the morphological data, was identified from coronal and sagittal reformat images and was classified as either lumbarization or sacralization. Morphometric data (IVDh, FIVh and FVAPd) were acquired from axial, sagittal, and coronal planes using both soft tissue and bone window settings. Results: The mean patient age was 41.6±13.0 years, with a female majority (55.8%). LSTV was predominantly lumbarization (96.4%), with sacralization in the remaining cases. The overall mean FVAPd was 11.2±2.4 mm, mean IVDh was 9.1±1.8 mm, and mean FIVh was 18.8±2.4 mm on the right and 19.1±2.4 mm on the left. IVDh levels were consistent across age groups, while FVAPd values were similar between genders. Patients aged 40 and under had higher FVAPd and FIVh levels, and male patients had higher IVDh and FIVh levels compared to females. Conclusions: The morphometric characteristics of LSTV may vary according to age and gender. Considering these factors in accurately identifying the anatomical variations of LSTV may play a significant role in determining appropriate treatment and management strategies.

Keywords

• lumbalisation
• lumbar canal
• lumbasacral transitional vertebra
• sacralisation
• sacral canal

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Binali Yıldırım University Clinical Research Ethics Committee (Approval Date: 30.03.2023, Number: 2023-07/4).

Lumbosakral geçiş vertebralarının semptomatik ve morfometrik analizi: yaş ve cinsiyete göre değerlendirmeler

Abstract

Amaç: Lumbosakral geçiş vertebraları (LSTV), bir omurun hem lumbal hem de sakral vertebra özelliklerini gösterdiği anatomik varyasyonlardır. Bu çalışma, LSTV'li hastalarda yaş ve cinsiyet farklılıklarını dikkate alarak, intervertebral disk yüksekliği (IVDh), vertebral foramenin anteroposterior çapı (FVAPd) ve intervertebral foramen yüksekliğini (FIVh) ölçerek anatomik değişiklikleri değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif çalışmaya LSTV tanısı almış 274 hasta dahil edilmiştir. Tüm MR görüntüleri 1.5T MR cihazı ve 32 kanallı lumbar coil ile elde edilmiştir. Morfolojik veriler oluşturan LSTV'nin varlığı, koronal ve sagittal reformat görüntülerden tespit edilerek lumbalizasyon veya sakralizasyon olarak sınıflandırılmıştır. Morfometrik veriler (IVDh, FIVh ve FVAPd), hem yumuşak doku hem de kemik pencere ayarları kullanılarak aksiyal, sagittal ve koronal düzlemlerden elde edilmiştir. Bulgular: Hastaların ortalama yaşı 41.6±13.0 yıl olup, çoğunluğu (%55.8) kadındır. LSTV vakalarının büyük çoğunluğu (%96.4) lumbalizasyon, geri kalan vakalar ise sakralizasyon şeklinde görülmüştür. Genel olarak ortalama FVAPd 11.2±2.4 mm, ortalama IVDh 9.1±1.8 mm, ortalama FIVh sağda 18.8±2.4 mm ve solda 19.1±2.4 mm olarak bulunmuştur. IVDh düzeyleri yaş grupları arasında tutarlılık gösterirken, FVAPd değerleri cinsiyet açısından benzerdi. 40 yaş ve altındaki hastalarda FVAPd ve FIVh düzeyleri daha yüksek, erkek hastalarda ise kadınlara kıyasla IVDh ve FIVh düzeyleri daha yüksek bulunmuştur. Sonuç: LSTV'nin morfometrik özellikleri yaş ve cinsiyete göre farklılık gösterebilir. Bu faktörlerin dikkate alınarak LSTV'nin anatomik varyasyonlarının doğru bir şekilde tanımlanması, uygun tedavi ve yönetim stratejilerinin belirlenmesinde önemli bir rol oynayabilir.

Keywords

• lumbalizasyon
• lomber kanal
• lumbosakral geçiş vertebrası
• sakralizasyon
• sakral kanal

References

1. Konin G P and Walz D M. Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol. 2010;31(10):1778-86. DOI: 10.3174/ajnr.A2036.
2. Jain A, Agarwal A, Jain S, and Shamshery C. Bertolotti syndrome: a diagnostic and management dilemma for pain physicians. Korean J Pain. 2013;26(4):368-73. DOI: 10.3344/kjp.2013.26.4.368.
3. Byvaltsev V A, Kalinin A A, Shepelev V V, et al. Prevalence of lumbosacral transitional vertebra among 4816 consecutive patients with low back pain: A computed tomography, magnetic resonance imaging, and plain radiographic study with novel classification schema. J Craniovertebr Junction Spine. 2023;14(1):35-43. DOI: 10.4103/jcvjs.jcvjs_149_22.
4. Mahato N K. Redefining lumbosacral transitional vertebrae (LSTV) classification: integrating the full spectrum of morphological alterations in a biomechanical continuum. Med Hypotheses. 2013;81(1):76-81. DOI: 10.1016/j.mehy.2013.02.026.
5. Mahato N K. Complexity of neutral zones, lumbar stability and subsystem adaptations: probable alterations in lumbosacral transitional vertebrae (LSTV) subtypes. Med Hypotheses. 2013;80(1):61-4. DOI: 10.1016/j.mehy.2012.10.013.
6. Bezuidenhout A F and Lotz J W. Lumbosacral transitional vertebra and S1 radiculopathy: the value of coronal MR imaging. Neuroradiology. 2014;56(6):453-7. DOI: 10.1007/s00234-014-1361-z.
7. Coskun Benlidayi I and Tirasci E. The effect of lumbosacral transitional vertebra on lumbar spine degeneration and spondylolisthesis among patients with low back pain. Pain Pract. 2024;24(1):52-61. DOI: 10.1111/papr.13280.
8. Yusof M I, Hassan M N, and Abdullah M S. The Relationship amongst Intervertebral Disc Vertical Diameter, Lateral Foramen Diameter and Nerve Root Impingement in Lumbar Vertebra. Malays Orthop J. 2018;12(1):21-25. DOI: 10.5704/MOJ.1803.004.

9. Jat S K, Srivastava A, Malhotra R, Chadha M, Tandon A, and Jain A K. Prevalence of lumbosacral transitional vertebra in patients with chronic low back pain: a descriptive cross-sectional study. Am J Neurodegener Dis. 2023;12(3):89-96.
10. Verhaegen J C F, Alves Batista N, Horton I, et al. Prevalence of Lumbosacral Transitional Vertebral Anomalies Among Healthy Volunteers and Patients with Hip Pathology: Association with Spinopelvic Characteristics. JB JS Open Access. 2023;8(1) DOI: 10.2106/JBJS.OA.22.00095.
11. Chiu C K, Chin T F, Chung W H, Chan C Y W, and Kwan M K. Variations in the Number of Vertebrae, Prevalence of Lumbosacral Transitional Vertebra and Prevalence of Cervical Rib Among Surgical Patients With Adolescent Idiopathic Scoliosis: An Analysis of 998 Radiographs. Spine (Phila Pa 1976). 2024;49(1):64-70. DOI: 10.1097/BRS.0000000000004711.
12. French H D, Somasundaram A J, Schaefer N R, and Laherty R W. Lumbosacral transitional vertebrae and its prevalence in the Australian population. Global Spine J. 2014;4(4):229-32. DOI: 10.1055/s-0034-1387808.
13. Tatara Y, Niimura T, Sekiya T, and Mihara H. Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae. JB JS Open Access. 2021;6(3) DOI: 10.2106/JBJS.OA.20.00167.
14. Shaikh A, Khan S A, Hussain M, et al. Prevalence of Lumbosacral Transitional Vertebra in Individuals with Low Back Pain: Evaluation Using Plain Radiography and Magnetic Resonance Imaging. Asian Spine J. 2017;11(6):892-97. DOI: 10.4184/asj.2017.11.6.892.
15. Nardo L, Alizai H, Virayavanich W, et al. Lumbosacral transitional vertebrae: association with low back pain. Radiology. 2012;265(2):497-503. DOI: 10.1148/radiol.12112747.
16. Ucar D, Ucar B Y, Cosar Y, et al. Retrospective cohort study of the prevalence of lumbosacral transitional vertebra in a wide and well-represented population. Arthritis. 2013;2013:461425. DOI: 10.1155/2013/461425.
17. Kot A, Polak J, Klepinowski T, et al. Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study. Surg Radiol Anat. 2022;44(3):431-41. DOI: 10.1007/s00276-021-02865-9.
18. Daniel P, Joel J J, and Rana P K. Lumbosacral transitional vertebrae in patients with low back pain: Radiological classification and morphometric analysis. Journal of the Anatomical Society of India. 2019;68(2):123-28.
19. Demir M, Atay E, Seringeç N, et al. Intervertebral disc heights and concavity index of the lumbar spine in young healthy adults. Anatomy. 2018;12(1):34-37.
20. Gopinathan P. Lumbar spinal canal stenosis-special features. J Orthop. 2015;12(3):123-5. DOI: 10.1016/j.jor.2015.06.001.
21. Kim K H, Park J Y, Kuh S U, Chin D K, Kim K S, and Cho Y E. Changes in spinal canal diameter and vertebral body height with age. Yonsei Med J. 2013;54(6):1498-504. DOI: 10.3349/ymj.2013.54.6.1498.
22. Ericksen M F. Aging in the lumbar spine. II. L1 and L2. Am J Phys Anthropol. 1978;48(2):241-5. DOI: 10.1002/ajpa.1330480219.
23. Masharawi Y, Salame K, Mirovsky Y, et al. Vertebral body shape variation in the thoracic and lumbar spine: characterization of its asymmetry and wedging. Clin Anat. 2008;21(1):46-54. DOI: 10.1002/ca.20532.
24. Devi R and Rajagopalan N. Morphometry of lumbar intervertebral foramen. Indian J Orthop. 2005;39(3):145-7.
25. Adams M A, Bogduk N, Burton K, and Dolan P, The Biomechanics of Back Pain-E-Book. 2012: Elsevier health sciences.
26. Jancuska J M, Spivak J M, and Bendo J A. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome. Int J Spine Surg. 2015;9:42. DOI: 10.14444/2042.
27. Türk G, Bilgili M, Acan A, and Koç A. Lumbosacral transitional vertebrae: An overlooked cause of back pain on MRI. Journal of Experimental and Clinical Medicine. 2023;40(1):62-65.
28. Yan S, Wang K, Zhang Y, Guo S, Zhang Y, and Tan J. Changes in L4/5 intervertebral foramen bony morphology with age. Scientific reports. 2018;8(1):7722.
29. Al-Hadidi M T, Abu-Ghaida J H, Badran D H, Al-Hadidi A M, Ramadan H N, and Massad D F. Magnetic resonance imaging of normal lumbar intervertebral foraminal height. Neurosciences (Riyadh). 2003;8(3):165-70.