LLUMBOSAKRAL TRANSİZYONEL VERTEBRA: END PLATE DEJENERASYONUNU HIZLANDIRIR MI ?

Öz

AMAÇ: Lumbosakral bileşkenin en sık görülen doğumsal anomalilerinden biri olan lumbosakral transizyonel vertebra (LSTV) genellikle tesadüfen saptanır. LSTV, geçiş segmentinin üzerindeki hareketi artırabilir ve erken dejenerasyonla ilişkili olabilir. Lomber omurganın dejenerasyonu, normal yaşlanmanın yanı sıra, intervertebral osteokondroz adı verilen nükleus pulposus ve vertebral uç plakaları etkileyen patolojik bir sürecin bir sonucu olabilir. Bu çalışmanın amacı, LSTV ile intervertebral osteokondroz arasındaki ilişkiyi değerlendirmektir.
GEREÇ VE YÖNTEM: 492 hastayı çalışmaya dahil ettik ve LSTV varlığına göre iki gruba ayırdık. LSTV olmayan hastalar kontrol grubu olarak sayıldı. LSTV grubundaki hastalar da geçiş omurlarının düzeyine göre sakralize ve lomberize olmak üzere iki gruba ayrıldı. Tüm gruplarda spondilolistezis, osteokondroz, Modic sinyal değişiklikleri, bel ağrısı ve sinir kökü semptomlarının varlığını kaydettik. Transizyonel vertebra düzeyinin bir üst seviyesindeki osteokondroz prevalansı ile transizyonel vertebrası olmayan hastalardaki aynı seviyeyi karşılaştırdık. Semptomların yaş dağılımını ve sıklığını iki grupta karşılaştırdık.
BULGULAR: LSTV grubunda Modic tip 2 sinyal değişikliklerinin ve intervertebral osteokondrozun daha yaygın olduğunu tespit ettik (% 42.7'ye karşı% 28.7 ve % 67.1'e karşı% 38.3, p <0.05). Sakralize hastalarda L4-5'teki, lomberize hastalarda L5-S1'de intervertebral osteokondroz prevelansı hem aynı grupta diğer seviyelere göre (sırasıyla % 52,7 ve % 63) hem de kontrol grubundaki aynı seviyelere göre anlamlı derecede yüksek bulundu (sırasıyla % 21,4 ve % 24,6). Bel ağrısı olan hastalar, LSTV grubunda daha fazlaydı ve daha erken yaşta görülmekteydi (p <0.05).
SONUÇ: Çalışmamızın sonucunda LSTV’nin intervertebral osteokondroz ve Modic tip 2 değişiklikleri ile ilişkili olduğunu bulduk. LSTV’si olan hastalar, vertebral kolondaki anormal yük aktarımı nedeniyle daha erken yaşta bel ağrısı ile başvurma eğilimindedir.

Anahtar Kelimeler

• Omurga
• Lumbosakral vertebra
• Transizyonel vertebra
• MRG.

LUMBOSACRAL TRANSITIONAL VERTEBRA: DOES IT ACCELERATE END PLATE DEGENERATION ?

Öz

OBJECTIVE: Lumbosacral transitional vertebra (LSTV) which is one of the most common congenital abnormalities of lumbosacral junction is usually detected incidentally. LSTV may increase the motion above transitional segment and be associated with early degeneration. Degeneration of lumbar spine may be a result of normal aging, as well as a pathological process that affects nucleus pulposus and vertebral end plates, which is called intervertebral osteochondrosis. The aim of this study is to evaluate the association between intervertebral osteochondrosis and lumbosacral transitional vertebra.
MATERIAL AND METHODS: We included 492 patients into the study and divided them into two groups depending on presence of LSTV. Patients without LSTV were counted as the control group. Patients in LSTV group was also classified into two groups as sacralized and lumbarized depending on the level of transitional vertebra. We noted the presence of spondylolisthesis, osteochondrosis, Modic signal changes, low back pain and nerve root symptoms in all groups. We compared osteochondrosis prevalences at one level above from transitional vertebrae to the same levels in patients without transitional vertebrae. We compared age distribution and frequency of sypmtoms in two groups.
RESULTS: We detected Modic type 2 signal changes and intervertebral osteochondrosis more common in LSTV group (42.7% vs 28.7% and 67.1% vs. 38.3%, p<0.05). Intervertebral osteochondrosis prevelance at L4-5 in sacralized patients (52.7%), and at L5-S1 in lumbarized patients (63%) was found significantly higher than other levels and the same levels in control group (21.4% and 24.6%). Patients with low back pain were more common in the LSTV group and were seen at younger age (p <0.05).
CONCLUSIONS: As a result of our study, we found that LSTV is associated with intervertebral osteochondrosis and Modic type 2 changes. Patients with transitional vertebrae tend to present with lower back pain at an earlier age due to abnormal load transfer in the vertebral column.

Anahtar Kelimeler

• Spine
• Lumbosacral vertebra
• Transitional vertebra
• MRI.

Kaynakça

1. 1. Konin GP, Walz DM. Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol. 2010;10:1778-86.
2. 2. Elster AD. Bertolotti's syndrome revisited. Transitional vertebrae of the lumbar spine. Spine. 1989,14(12):1373-77.
3. 3. Luoma K, Vehmas T, Raininko R et al. Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine. 2004;29:200–5.
4. 4. Wigh RE, Anthony Jr HF. Transitional lumbosacral discs. Probability of herniation. Spine. 1981;6(2)():168-71.
5. 5. O’Driscoll CM, Irwin A, Saifuddin A. Variations in morphology of the lumbosacral junction on sagittal MRI: correlation with plain radiography. Skeletal Radiology. 1996; 25(3):225-30.
6. 6. Desmond PM, Buirski G. Magnetic resonance appearances of developmental disc anomalies in the lumbar spine. Australasian Radiology. 1993;37(1):26-9.
7. 7. Jönsson B, Strömqvist B, Egund N. Anomalous lumbosacral articulations and low-back pain. Evaluation and treatment. Spine. 1989;14(8):831-4.
8. 8. Aihara, T, Takahashi K, Ogasawara A, et al. Intervertebral disc degeneration associated with lumbosacral transitional vertebrae: a clinical and anatomical study. J Bone Joint Surg Br. 2005; 87(5): 687-91.

9. 9. Avimadje M, Goupille P, Jeannou J, et al. Can an anomalous lumbo-sacral or lumbo-iliac articulation cause low back pain? A retrospective study of 12 cases. Revue du Rhumatisme (English ed.). 1999;66(1):35-9.
10. 10. Santavirta S, Tallroth K, Ylinen P, et al. Surgical treatment of Bertolotti's syndrome. Archives of Orthopaedic and Trauma Surgery. 1993;112(2):82-7.
11. 11. Brault et al. Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain. Spine. 2001;26(2): 226-9.
12. 12. Fardon DF, Williams AL, Dohring EJ, et al. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The Spine Journal. 2014;14(11):2525-45.
13. 13. Carrino JA, Campbell Jr PD, Lin DC, et al. Effect of spinal segment variants on numbering vertebral levels at lumbar MR imaging. Radiology. 2011;259(1):196-202.
14. 14. Lian J, Levine N, Cho W. A review of lumbosacral transitional vertebrae and associated vertebral numeration. European Spine Journal. 2018;27(5):995-1004.
15. 15. Tokgoz N, Ucar M, Erdogan AB, et al. Are spinal or paraspinal anatomic markers helpful for vertebral numbering and diagnosing lumbosacral transitional vertebrae?. Korean Journal of Radiology. 2014;15(2):258-66.
16. 16. Modic MT, Steinberg PM, Ross JS, et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988:193-199.
17. 17. Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology. 1988; 168(1):177-86.
18. 18. Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. European Spine Journal. 2008;17(3):327-35.
19. 19. Dar G, Peled N. The association between sacralization and spondylolisthesis. Anatomical Science International. 2014;89(3):156-60.
20. 20. Toyone T, Takahashi K, Kitahara H, et al. Vertebral bone-marrow changes in degenerative lumbar disc disease. An MRI study of 74 patients with low back pain. The Journal of Bone and Joint Surgery. 1994;76(5):757-64.
21. 21. Braithwaite I, White J, Saifuddin A, et al. Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. European Spine Journal. 1998;7(5):363-8.
22. 22. Mitra D, Cassar-Pullicino N, McCall IV. Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. European Radiology. 2004;14(9):1574-81.
23. 23. Vergauwen S, Parizel PM, van Breusegem L, et al. Distribution and incidence of degenerative spine changes in patients with a lumbo-sacral transitional vertebra. European Spine Journal. 1997; 6(3):168-172.
24. 24. Resnick D, Niwayama G (Edited by). Diagnosis of Bone and Joint Disorders. 3rd Edition, Philadelphia: WB Saunders Company. 1995: 1372-1462.
25. 25. Schmorl G, Junghanns H (Edited by) The human spine in health and disease. 2nd. New York: Grune and Stratton. 1971:141–148.
26. 26. McNally DS, Adams MA. Internal intervertebral disc mechanics as revealed by stress profilometry. Spine. 1992; 17(1):66-73.
27. 27. Fujiwara A, Tamai K, An HS, et al. Orientation and osteoarthritis of the lumbar facet joint. Clinical Orthopaedics and Related Research. 2001; (385):88-94.
28. 28. Yoshida H, Fujiwara A, Tamai K, et al. Diagnosis of symptomatic disc by magnetic resonance imaging: T2-weighted and gadolinium-DTPA-enhanced T1-weighted magnetic resonance imaging. Clinical Spine Surgery. 2002;15(3):193-8.
29. 29. Murata M, Morio Y, Kuranobu K. Lumbar disc degeneration and segmental instability: a comparison of magnetic resonance images and plain radiographs of patients with low back pain. Archives of Orthopaedic and Trauma Surgery. 1994;113(6):297-301.
30. 30. Tini PG, Wieser C, Zinn WM. The transitional vertebra of the lumbosacral spine: its radiological classification, incidence, prevalence, and clinical significance. Rheumatology. 1977;16(3):180-5.
31. 31. Gopalan B, Yerramshetty JS. Lumbosacral transitional vertebra-related low back pain: resolving the controversy. Asian Spine Journal. 2018;12(3):407.
32. 32. Mulholland RC. The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain. European Spine Journal. 2008;17(5):619-25.