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
Vadim A Byvaltsev1, Andrei A Kalinin2, Valery V Shepelev3, Yurii Ya Pestryakov3, Marat A Aliyev4, Dmitriy V Hozeev3, Mikhail Y Biryuchkov5, Rustem A Kundubayev5, K Daniel Riew6
1 Department of Neurosurgery, Irkutsk State Medical University; Department of Neurosurgery, Railway Clinical Hospital; Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
2 Department of Neurosurgery, Irkutsk State Medical University; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
3 Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
4 Department of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
5 Department of Neurosurgery with Traumatology Course, West Kazakhstan Marat Ospanov Medical Unversity, Aktobe, Kazakhstan
6 Department of Orthopedic Surgery, Columbia University; Department of Neurological Surgery, Weill Cornell Medical School, New York City, New York, USA
Vadim A Byvaltsev
No. 1 Krassnogo Vosstaniya Street, Off 201, Irkutsk - 664 003, Irkutskaya Oblast’
Source of Support: None, Conflict of Interest: None
Study Design: A retrospective single-center study.
Background: The prevalence of the lumbosacral anomalies remains controversial. The existing classification to characterize these anomalies is more complex than necessary for clinical use.
Purpose: To assessment of the prevalence of lumbosacral transitional vertebra (LSTV) in patients with low back pain and the development of clinically relevant classification to describe these anomalies.
Materials and Methods: During the period from 2007 to 2017, all cases of LSTV were preoperatively verified, and classified according to Castellvi, as well as O'Driscoll. We then developed modifications of those classifications that are simpler, easier to remember, and clinically relevant. At the surgical level, this was assessed intervertebral disc and facet joint degeneration.
Results: The prevalence of the LSTV was 8.1% (389/4816). The most common L5 transverse process anomaly type was fused, unilaterally or bilaterally (48%), to the sacrum and were O'Driscoll's III (40.1%) and IV (35.8%). The most common type of S1-2 disc was a lumbarized disc (75.9%), where the disc's anterior-posterior diameter was equal to the L5-S1 disc diameter. In most cases, neurological compression symptoms (85.5%) were verified to be due to spinal stenosis (41.5%) or herniated disc (39.5%). In the majority of patients without neural compression, the clinical symptoms were due to mechanical back pain (58.8%).
Conclusions: LSTV is a fairly common pathology of the lumbosacral junction, occurring in 8.1% of the patients in our series (389 out of 4,816 cases). The most common types were Castellvi's type IIA (30.9%) and IIIA (34.9%) and were O'Driscoll's III (40.1%) and IV (35.8%).