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Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae

The presence of a thoracolumbar transitional vertebra (TLTV) and/or lumbosacral transitional vertebra (LSTV) may cause wrong-site surgery and problems while measuring spinopelvic parameters, including pelvic incidence and lumbar lordosis. The Castellvi classification of LSTV addresses coronal images...

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Autores principales: Tatara, Yasunori, Niimura, Takanori, Sekiya, Tatsuhiro, Mihara, Hisanori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Journal of Bone and Joint Surgery, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280013/
https://www.ncbi.nlm.nih.gov/pubmed/34278183
http://dx.doi.org/10.2106/JBJS.OA.20.00167
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author Tatara, Yasunori
Niimura, Takanori
Sekiya, Tatsuhiro
Mihara, Hisanori
author_facet Tatara, Yasunori
Niimura, Takanori
Sekiya, Tatsuhiro
Mihara, Hisanori
author_sort Tatara, Yasunori
collection PubMed
description The presence of a thoracolumbar transitional vertebra (TLTV) and/or lumbosacral transitional vertebra (LSTV) may cause wrong-site surgery and problems while measuring spinopelvic parameters, including pelvic incidence and lumbar lordosis. The Castellvi classification of LSTV addresses coronal images but not sagittal or axial images. Therefore, it is unclear how LSTV differs from the normal lumbosacral anatomy. We aimed to investigate the lumbosacral anatomy and vertebral numbering in patients with TLTV and/or LSTV. We performed computed tomography (CT) to identify TLTV, to number presacral vertebrae accurately, and to analyze morphological differences in each LSTV type. METHODS: The medical records of 880 patients who underwent spinopelvic fixation between July 2014 and March 2020 were evaluated for TLTV and LSTV. Castellvi LSTVs (above the promontory on the arcuate line of the ilium) and our newly proposed LSTV (“S6 LSTV,” with 6 sacral vertebrae and 5 foramina below the promontory) were analyzed. The anatomical location of the lowest thoracic vertebra was defined, and TLTV with dysplastic ribs was identified. Each LSTV type was examined for its morphological features on sagittal and axial CT images. RESULTS: LSTV was observed in 111 (12.6%) of 880 patients. Castellvi type-III LSTV was the most common (42 [37.8%] of 111), followed by S6 LSTV (37 [33.3%] of 111). TLTV was associated with LSTV (87 [78.4%] of 111) and was commonly identified at T13 (59 [67.8%] of 87). On sagittal CT images, the lumbosacral transitional anatomy of Castellvi LSTVs resembled that of normal L5-S1, and the lumbosacral transitional anatomy of S6 LSTV resembled that of normal S1-S2. When comparing the S1 upper segments on axial CT images, most Castellvi LSTVs exhibited S2-like appearances and most S6 LSTVs exhibited L5-like appearances. CONCLUSIONS: Although LSTV possesses L5 and S1 features, Castellvi LSTVs have more L5 elements than S1 elements. The converse is true for S6 LSTV. At least for the Castellvi type-IIIb LSTV, the vertebra below the Castellvi type-IIIb LSTV should be recognized as S1, but clinically it is better to recognize it as S2. Overlooking TLTV may cause problems in vertebral numbering due to coexisting LSTV. CLINICAL RELEVANCE: Three-dimensional CT images are suitable for detecting transitional vertebrae. This study reveals their morphological features on axial CT images and their lumbosacral anatomy on sagittal CT images.
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spelling pubmed-82800132021-07-16 Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae Tatara, Yasunori Niimura, Takanori Sekiya, Tatsuhiro Mihara, Hisanori JB JS Open Access Scientific Articles The presence of a thoracolumbar transitional vertebra (TLTV) and/or lumbosacral transitional vertebra (LSTV) may cause wrong-site surgery and problems while measuring spinopelvic parameters, including pelvic incidence and lumbar lordosis. The Castellvi classification of LSTV addresses coronal images but not sagittal or axial images. Therefore, it is unclear how LSTV differs from the normal lumbosacral anatomy. We aimed to investigate the lumbosacral anatomy and vertebral numbering in patients with TLTV and/or LSTV. We performed computed tomography (CT) to identify TLTV, to number presacral vertebrae accurately, and to analyze morphological differences in each LSTV type. METHODS: The medical records of 880 patients who underwent spinopelvic fixation between July 2014 and March 2020 were evaluated for TLTV and LSTV. Castellvi LSTVs (above the promontory on the arcuate line of the ilium) and our newly proposed LSTV (“S6 LSTV,” with 6 sacral vertebrae and 5 foramina below the promontory) were analyzed. The anatomical location of the lowest thoracic vertebra was defined, and TLTV with dysplastic ribs was identified. Each LSTV type was examined for its morphological features on sagittal and axial CT images. RESULTS: LSTV was observed in 111 (12.6%) of 880 patients. Castellvi type-III LSTV was the most common (42 [37.8%] of 111), followed by S6 LSTV (37 [33.3%] of 111). TLTV was associated with LSTV (87 [78.4%] of 111) and was commonly identified at T13 (59 [67.8%] of 87). On sagittal CT images, the lumbosacral transitional anatomy of Castellvi LSTVs resembled that of normal L5-S1, and the lumbosacral transitional anatomy of S6 LSTV resembled that of normal S1-S2. When comparing the S1 upper segments on axial CT images, most Castellvi LSTVs exhibited S2-like appearances and most S6 LSTVs exhibited L5-like appearances. CONCLUSIONS: Although LSTV possesses L5 and S1 features, Castellvi LSTVs have more L5 elements than S1 elements. The converse is true for S6 LSTV. At least for the Castellvi type-IIIb LSTV, the vertebra below the Castellvi type-IIIb LSTV should be recognized as S1, but clinically it is better to recognize it as S2. Overlooking TLTV may cause problems in vertebral numbering due to coexisting LSTV. CLINICAL RELEVANCE: Three-dimensional CT images are suitable for detecting transitional vertebrae. This study reveals their morphological features on axial CT images and their lumbosacral anatomy on sagittal CT images. Journal of Bone and Joint Surgery, Inc. 2021-07-14 /pmc/articles/PMC8280013/ /pubmed/34278183 http://dx.doi.org/10.2106/JBJS.OA.20.00167 Text en Copyright © 2021 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Scientific Articles
Tatara, Yasunori
Niimura, Takanori
Sekiya, Tatsuhiro
Mihara, Hisanori
Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae
title Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae
title_full Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae
title_fullStr Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae
title_full_unstemmed Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae
title_short Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae
title_sort changes in lumbosacral anatomy and vertebral numbering in patients with thoracolumbar and/or lumbosacral transitional vertebrae
topic Scientific Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280013/
https://www.ncbi.nlm.nih.gov/pubmed/34278183
http://dx.doi.org/10.2106/JBJS.OA.20.00167
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