Evaluation of scoliosis in patients with lumbosacral transitional vertebra

Abstract

Aim: Lumbosacral transitional vertebra and scoliosis both have the potential to alter spinal balance, along with psoas muscles, which are important in the maintenance of spinal alignment. In this study we aimed to evaluate the relationship between lumbosacral transitional vertebrae and their potential influence on lumbar alignment.
Methods: In this cross-sectional study, lumbar Magnetic Resonance Imaging (MRI) studies that are referred to our Radiology Department between January 2017 and July 2017 were evaluated. 125 patients with lumbosacral transitional vertebra and 125 patients without any history of previous spinal surgery, trauma, inflammatory or infectious diseases were included. Type of transitional vertebra (unilateral/bilateral), presence of scoliosis and psoas muscle diameter-area measurements were evaluated.
Results: Among the transitional vertebra group, 75 patients had unilateral and 50 had bilateral sacralization. Among sacralization patients, 52.8% also had scoliosis. The presence of scoliosis was significantly lower in patients with bilateral sacralization compared to those with unilateral sacralization (P=0.001). The psoas muscle cross-sectional area and diameters were also further evaluated for the presence of asymmetry in the scoliosis group. Measurements were made twice by one radiologist and the mean value was used for statistical analysis. Results showed that area and transverse diameter asymmetries were statistically significant in patients with scoliosis (P=0.001 and P=0.003, respectively).
Conclusions: Lumbosacral transitional vertebra deteriorates spinal alignments and particularly when unilateral, may cause scoliosis and psoas muscle asymmetry. The pathophysiology of psoas muscle asymmetry, however, is controversial and should be further evaluated. 

Keywords

• Lumbosacral transitional vertebra
• Magnetic resonance imaging
• Scoliosis
• Psoas muscles

Lumbosakral tranzisyonel vertebralı hastalarda skolyozun değerlendirilmesi

Öz

Amaç: Lumbosakral tranzsiyonel vertebra ve skolyozun her ikisinin de spinal dengeyi değiştirebilecek potansiyel etkileri bulunmaktadır. Psoas kasları ise spinal dengenin sağlanmasında önemli göreve sahiptir. Bu çalışmada lumbosakral tranzisyonel vertebra ile spinal dizilim arasındaki ilişkiyi değerlendirmeyi amaçladık.
Yöntemler: Bu kesitsel çalışmada hastanemizin Radyoloji Bölümü’nde Ocak 2017-Temmuz 2017 tarihleri arasında çekilen Lomber Manyetik Rezonans Görüntüleme tetkikleri retrospektif olarak değerlendirildi. Tranzisyonel vertebralı 125 hasta ile spinal cerrahi, travma, inflamatuar ya da enfeksiyöz bir hastalık öyküsü bulunmayan 125 hasta control grubu olarak çalışmaya dahil edildi. Tranzisyonel vertebranın yönü (unilateral, bilateral), skolyoz varlığı ve psoas kası çap ile alanları değerlendirildi.
Bulgular: Tranzisyonel vertebralı hastaların 75’i unilateral 50’si ise bilateral sakralizasyona sahipti. Sakralizasyonu olan hastaların %52,8’inde aynı zamanda skolyoz mevcuttu. Bilateral sakralizasyonu olan hastalarda unilateral sakralizasyonu olan hastalara kıyasla skolyoz anlamlı derecede daha az saptandı (P=0,001). Skolyoz grubunda psoas kası asimetri durumunu saptamak için psoas kas çapları ve kesitsel alanları değerlendirildi. Ölçümler aynı radyolog tarafından iki kere yapılarak ortalama değer istatistiksel değerlendirmede kullanıldı. Skolyozlu hastalarda psoas kaslarının alanlarında ve transvers çaplarında anlamlı oranda asimetri olduğu görüldü (sırasıyla P=0,001 ve P=0,003).
Sonuç: Lumbosakral tranzisyonel vertebra spinal dizilimi bozmakta ve özellikler tek taraflı olduğunda skolyoza ve psoas kası asimetrisine neden olmaktadır. Psoas kası asimetrisinin altındaki patofizyoloji kesin olmayıp ileri çalışmalarla desteklenmelidir.

Anahtar Kelimeler

• Lumbosakral tranzisyonel vertebra
• Manyetik rezonans görüntüleme
• Skolyoz
• Psoas kası

Kaynakça

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