Prevalence of lumbosacral transitional vertebra on lumbar CT and associated degenerative imaging findings in symptomatic patients

Yıl 2025, Cilt: 18 Sayı: 4, 3 - 3

Ergin Sağtaş , Hakkı Peker

Öz

Purpose: This study aimed to assess the prevalence and distribution of lumbosacral transitional vertebra (LSTV) subtypes in patients with low back pain and investigate associated degenerative changes using lumbar CT imaging.
Methods: A retrospective review of 1.035 patients who underwent lumbar CT for low back pain between January 2023 and April 2024 was conducted. 133 with LSTV were identified and classified according to the Castellvi classification. The degenerative changes at the LSTV level, including pseudoarticular degeneration, disc narrowing, facet joint arthropathy, foraminal stenosis, and scoliosis, were evaluated.
Results: LSTV was present in 12.85% of the patient population. Degeneration at the pseudoarticulation was observed in 67.7% of cases, with Types II and IV showing significantly higher rates (98.2% and 100%) compared to Types I (60%) and III (0%). Disc narrowing at the cephalad level was most common in Type III (90%). Facet joint arthropathy was observed in 85.7% of cases, while foraminal stenosis was only found in Type II (9.8%). Scoliosis was more prevalent in Types II (50.9%) and IV (50%) than in Types I (24%) and III (4.5%). Statistically significant differences were observed in pseudoarticular degeneration, disc narrowing, foraminal stenosis, and scoliosis.
Conclusion: LSTV is common in low back pain patients, with Types II and IV showing early degeneration at the pseudoarticulation level that may contribute to symptoms, particularly in young and middle-aged individuals. Nerve root compression due to degenerative hypertrophy is common in Type II and requires careful examination of the LSTV region with imaging methods in symptomatic cases.

Anahtar Kelimeler

Lumbosacral transitional vertebra, computed tomography, pseudoarticulation, low back pain

Semptomatik hastalarda lomber BT’de lumbosakral transisyonel vertebra prevalansı ve eşlik eden dejeneratif görüntüleme bulguları

Öz

Amaç: Bu çalışmanın amacı, bel ağrısı nedeniyle lomber BT çekilen hastalarda lumbosakral transisyonel vertebra (LSTV) yaygınlığını ve alt tiplerinin dağılımını değerlendirmek ve ilişkili dejeneratif değişiklikleri araştırmaktır.
Gereç ve yöntem: Ocak 2023 ile Nisan 2024 arasında bel ağrısı nedeniyle lomber BT çekilen 1.035 hastanın retrospektif incelemesi yapıldı. LSTV'li 133 hasta belirlendi ve Castellvi sınıflandırmasına göre sınıflandırıldı. Psödoartiküler dejenerasyon, disk daralması, faset eklem artropatisi, foraminal stenoz ve skolyoz dahil olmak üzere LSTV seviyesindeki dejeneratif değişiklikler değerlendirildi.
Bulgular: LSTV hasta popülasyonunun %12,85'inde saptandı. Psödoartiküler dejenerasyon vakaların %67,7'sinde gözlendi ve Tip II ve IV'te Tip I (%60) ve III (%0) ile karşılaştırıldığında önemli ölçüde daha yüksek oranlar (%98,2 ve %100) görüldü. Sefalad disk daralması Tip III'te (%90) en yaygındı. Faset eklem artropatisi vakaların %85,7'sinde gözlenirken, foraminal stenoz yalnızca Tip II'de (%9,8) bulundu. Skolyoz Tip II'de (%50,9) ve IV'te (%50) Tip I (%24) ve III'e (%4,5) göre daha yaygındı. Psödoartiküler dejenerasyon, disk daralması, foraminal stenoz ve skolyozda istatistiksel olarak anlamlı farklılıklar gözlendi.
Sonuç: LSTV bel ağrısı hastalarında yaygındır. Tip II ve IV'te psödoartikülasyon seviyesinde erken dejenerasyon görülür ve bu özellikle genç ve orta yaşlı bireylerde semptomlara katkıda bulunabilir. Dejeneratif hipertrofiye bağlı sinir kökü sıkışması Tip II'de yaygındır ve semptomatik vakalarda görüntüleme yöntemleriyle LSTV bölgesinin dikkatli bir şekilde incelenmesini gerektirir.

Anahtar Kelimeler

Lumbosakral transisyonel vertebra, bilgisayarlı tomografi, psödoartikülasyon, bel ağrısı

Kaynakça

• 1. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. doi:10.1016/S0140-6736(16)30970-9
• 2. Türk G, Bilgili M, Acan A, Koç A. Lumbosacral transitional vertebrae: An overlooked cause of back pain on MRI. J. Exp. Clin. Med. March 2023;40(1):62-65.
• 3. Farshad Amacker NA, Herzog RJ, Hughes AP, Aichmair A, Farshad M. Associations between lumbosacral transitional anatomy types and degeneration at the transitional and adjacent segments. Spine J. 2015;15(6):1210-1216. doi:10.1016/j.spinee.2013.10.029
• 4. Alonzo F, Cobar A, Cahueque M, Prieto JA. Bertolotti's syndrome: an underdiagnosed cause for lower back pain. J Surg Case Rep. 2018;2018(10):rjy276. Published 2018 Oct 17. doi:10.1093/jscr/rjy276
• 5. Jancuska JM, Spivak JM, Bendo JA. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome. Int J Spine Surg. 2015;9:42. Published 2015 Jul 29. doi:10.14444/2042
• 6. Konin GP, Walz DM. Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol. 2010;31(10):1778-1786. doi:10.3174/ajnr.A2036
• 7. McGrath KA, Rabah NM, Steinmetz MP. Identifying treatment patterns in patients with Bertolotti syndrome: an elusive cause of chronic low back pain. Spine J. 2021;21(9):1497-1503. doi:10.1016/j.spinee.2021.05.008
• 8. Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976). 1984;9(5):493-495. doi:10.1097/00007632-198407000-00014
• 9. Hou L, Bai X, Li H, et al. Lumbar plain radiograph is not reliable to identify lumbosacral transitional vertebra types according to Castellvi classification principle. BMC Musculoskelet Disord. 2020;21(1):333. Published 2020 May 29. doi:10.1186/s12891-020-03358-3
• 10. Zhu W, Ding X, Zheng J, et al. A systematic review and bibliometric study of Bertolotti's syndrome: clinical characteristics and global trends. Int J Surg. 2023;109(10):3159-3168. Published 2023 Oct 1. doi:10.1097/JS9.0000000000000541
• 11. McGrath K, Schmidt E, Rabah N, Abubakr M, Steinmetz M. Clinical assessment and management of Bertolotti Syndrome: a review of the literature. Spine J. 2021;21(8):1286-1296. doi:10.1016/j.spinee.2021.02.023
• 12. Hanhivaara J, Määttä JH, Niinimäki J, Nevalainen MT. Lumbosacral transitional vertebrae are associated with lumbar degeneration: retrospective evaluation of 3855 consecutive abdominal CT scans. Eur Radiol. 2020;30(6):3409-3416. doi:10.1007/s00330-020-06691-2
• 13. Vinha A, Bártolo J, Lemos C, Cordeiro F, Rodrigues-Pinto R. Lumbosacral transitional vertebrae: prevalence in a southern European population and its association with low back pain. Eur Spine J. 2022;31(12):3647-3653. doi:10.1007/s00586-022-07415-4
• 14. Videman T, Battié MC, Ripatti S, Gill K, Manninen H, Kaprio J. Determinants of the progression in lumbar degeneration: a 5-year follow-up study of adult male monozygotic twins. Spine (Phila Pa 1976). 2006;31(6):671-678. doi:10.1097/01.brs.0000202558.86309.ea
• 15. Kalichman L, Kim DH, Li L, Guermazi A, Hunter DJ. Computed tomography-evaluated features of spinal degeneration: prevalence, intercorrelation, and association with self-reported low back pain. Spine J. 2010;10(3):200-208. doi:10.1016/j.spinee.2009.10.018
• 16. Kalichman L, Li L, Kim DH, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila Pa 1976). 2008;33(23):2560-2565. doi:10.1097/BRS.0b013e318184ef95
• 17. Vergauwen S, Parizel PM, van Breusegem L, et al. Distribution and incidence of degenerative spine changes in patients with a lumbo-sacral transitional vertebra. Eur Spine J. 1997;6(3):168-172. doi:10.1007/BF01301431
• 18. Van Goethem J, Van Campenhout A, van den Hauwe L, Parizel PM. Scoliosis. Neuroimaging Clin N Am. 2007;17(1):105-115. doi:10.1016/j.nic.2006.12.001
• 19. Koslosky E, Gendelberg D. Classification in Brief: The Meyerding Classification System of Spondylolisthesis. Clin Orthop Relat Res. 2020;478(5):1125-1130. doi:10.1097/CORR.0000000000001153
• 20. 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
• 21. Porter NA, Lalam RK, Tins BJ, Tyrrell PN, Singh J, Cassar-Pullicino VN. Prevalence of extraforaminal nerve root compression below lumbosacral transitional vertebrae. Skeletal Radiol. 2014;43(1):55-60. doi:10.1007/s00256-013-1750-0
• 22. Kanematsu R, Hanakita J, Takahashi T, Minami M, Tomita Y, Honda F. Extraforaminal entrapment of the fifth lumbar spinal nerve by nearthrosis in patients with lumbosacral transitional vertebrae. Eur Spine J. 2020;29(9):2215-2221. doi:10.1007/s00586-020-06460-1
• 23. Aihara T, Takahashi K, Ogasawara A, Itadera E, Ono Y, Moriya H. Intervertebral disc degeneration associated with lumbosacral transitional vertebrae: a clinical and anatomical study. J Bone Joint Surg Br. 2005;87(5):687-691. doi:10.1302/0301-620X.87B5.15727