Objective Lumbosacral transitional vertebras (LSTVs) are common in the general population, but their potential impact on the sacroiliac joints is unclear. We aimed to determine the prevalence of LSTVs and to assess their associations with sacroiliitis by standard radiography and MRI in a population with suspected axial spondyloarthritis. Methods The data were from the DESIR cohort of 688 patients aged 18–50 years with inflammatory low back pain for ⩾3 months but <3 years suggesting axial spondyloarthritis. The baseline pelvic radiographs were read by two blinded readers for the presence and type (Castellvi classification) of LSTVs. Associations between LSTVs and other variables collected at baseline and at the diagnosis were assessed using the χ2 test (or Fisher's exact test) or the Mann–Whitney test. Results LSTV was found in 200/688 (29.1%) patients. Castellvi type was Ia in 54 (7.8%), Ib in 76 (11.0%), IIa in 20 (2.9%), IIb in 12 (1.7%), IIIa in 7 (1.0%), IIIb in 21 (3.0%) and IV in 10 (1.4%) patients. Compared with the group without LSTVs, the group with LSTVs had higher proportions of patients meeting modified New York criteria for radiographic sacroiliitis (19% vs 27%, respectively; P = 0.013) and Assessment of SpondyloArthritis international Society MRI criteria for sacroiliitis (29% vs 39%, respectively; P = 0.019). Conclusion In patients with inflammatory back pain suggesting axial spondyloarthritis, LSTVs are associated with both radiographic and MRI sacroiliitis.
BackgroundLumbosacral transitional vertebra (LSTV) is a congenital anomaly of the lumbosacral transition reported in 16% to 36% of the general population. One study reported low clinical relevance of LSTV in the early diagnosis of axial spondyloarthritis (axSpA), but data remains scarce.ObjectivesOur objectives were to evaluate the association of LSTV with sacroiliitis on conventional radiographs (CR) and magnetic resonance imaging (MRI) in a population with inflammatory back pain (IBP) suspected of axSpA.MethodsBaseline pelvic and lumbar CR of DESIR cohort patients (18–50 years, IBP≥3 months but <3 years and suspicion of axSpA) were analysed by readers blinded to clinical and other radiologic information. Baseline sacroiliac joint MRI had been read for sacroiliitis according to the ASAS definition. Radiographic sacroiliitis was defined according to the modified New York classification (mNYc). Unilateral sacroiliitis was defined as at least grade 2 according to the mNYc. LSTV were defined on radiographs, according to Castellvi classification: 0 normal; 1 enlarged transverse processes (a=unilateral, b=bilateral); 2 pseudo-articulation with the sacral bone (a=unilateral, b=bilateral); 3 fusion with the sacral bone (a=unilateral, b=bilateral); 4 pseudo-articulation on one side and fusion on the other. Imaging data collected at inclusion were compared in patients with LSTV versus patients without using Chi-square test or exact Fischer’s test when appropriate.Results688 patients with available CR enabling LSTV analysis were studied, 47% were men, mean age was 33 years, 64% fulfilled ASAS criteria. Among the 688 patients 29.1% presented LSTV. Number and percentages of patients with different classes of LSTV are presented in Table I. Patients with LSTV had more often sacroiliitis on CR than patients without, respectively 27% and 19% (p=0.013). Patients with LSTV had more often sacroiliitis on MRI (figure 1) than patients without, respectively 39% and 29% (p=0.019). Presence of fusion on the right transverse process was associated with both right (p=0.001) and left (p=0.001) sacroiliitis on CR. Presence of fusion on the left transverse process was associated with sacroiliitis in CR on both right (p=0.006) and left (p=0.001) sides.Table I: Prevalence of LSTV in the DESIR cohort (for stage 4, laterality is for the fusion)CastellviLateralityNumber (%) I aRight26 (3.8)(Mega-apophysis)Left28 (4.1)I b76 (11.0)II aRight13 (1.9)(New articulation)Left7 (1.0)II b12 (1.7)III aRight3 (0.4)(Fusion)Left4 (0.6)III b21 (3.0)IVRight3 (0.4)(New articulation and fusion)Left7 (1.0)Abstract SAT0637 – Figure 1A case of LSTV (class 4 from Castellvi classification) associated to CR (A) and MRI. T1 weighted sequence is shown in B and STIR weighted sequence in C and D.ConclusionsLSTV is observed in 29.1% of patients from the DESIR cohort, as reported in the literature and is associated with sacroiliitis on conventional radiography and MRI. Further study is mandatory to understand if this is based on mechanical stress or AxSpA and to assess the pot...
ObjectivesTo evaluate the impact of scoliosis on both clinical presentation and lumbar imaging of early inflammatory back pain suggestive of spondyloarthritis.MethodsThe DESIR cohort is a prospective longitudinal cohort study of adults aged 18–50 with inflammatory back pain (IBP) ≥3 months, ≤3 years. Baseline lumbar X-Rays of patients included in DESIR cohort were read by two central blinded fellow readers (and a rheumatologist spine specialist in case of discrepancy) for presence or not of scoliosis (defined as a Cobb angle>10° and a Nash Moe grade≥1). Associations between scoliosis and baseline clinical variables, presence of X-Rays (New York) and MRI (ASAS and MORPHO proposal definition) sacroiliitis, presence of spinal signs of spondyloarthritis (mSASSS, BASRI-total, SPARCC scores), presence of spinal degenerative MRI signs on X-rays (yes or no) and MRI (presence of Modic abnormalities, Pfirrmann score, Canal stenosis, Extrusion, High intensity zone Facet osteoarthritis) according to central reading (two readers) and axSpA diagnostic confidence (according to local clinician's confidence on a 0–10 visual analogic scale) were assessed by univariate analysis using the chi-square test (or Fisher's exact test where appropriate) and the Mann-Whitney test. Adjustment for multiple testing was performed according to Bonferroni method.Results675 patients (47.1% men, mean age of 33.6 years, 89.6% had lumbar pain, 65% fulfilling ASAS criteria) were studied. The mean Cobb angle was 3.2° (± 4.8) and 49/675 (7.3%) patients had lumbar scoliosis. The only significant difference was the lumbosacral sagittal balance. Indeed, scoliotic patients had greater lumbar lordosis (57.8° versus 50.9°; p<0.001) than non-scoliotic. About MRI findings, spinal degenerative manifestations were very scarce in both groups. The major part of degenerative changes was in the two last lumbar discs and vertebras, without significant difference between scoliotic and non-scoliotic patients.ConclusionsScoliotic patients with inflammatory back pain suggestive of spondyloarthritis do not have more lumbar degenerative lesions than non-scoliotic patients, nor difference of clinical presentation, but they have greater lumbar lordosis.Disclosure of InterestNone declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.