Co-existence of spina bifida occulta and lumbosacral transitional vertebra in patients presenting with lower back pain

Abstract

Lower back pain is a common symptom, which is managed by various specialties including neurology, orthopedics, general medicine, and rheumatology. Lumbosacral transitional vertebra (LSTV) is an important cause of back pain, about which many clinicians are unfamiliar. It is a congenital malformation of the spine, which results from abnormal fusion of the sacrum with the vertebra above, to a variable extent. An extra joint is formed between the ala of sacrum and the elongated transverse process of the vertebra above on one or both sides. It leads to altered rotational movement of the lower spine, which gives rise to back pain. Spina bifida occulta (SBO) is another congenital malformation of the spine, which is detected incidentally because it does not cause any symptoms. We observed frequent co-existence of SBO and LSTV in patients attending our rheumatology clinic for lower back pain.

Surgical management of complex lumbosacral anomaly with minimally invasive spinal fusion: A clinical image

“…Recent literature data report that concurrent presence of LSTV with SBO in lumbosacral junction represents a rather frequent finding 2 . Furthermore, coexistence of SBO with spondylolysis is consistently reported from various authors, with the predominant proposed mechanism involving the increased loading on pars interarticularis due to defective posterior muscular, ligamentous, and osseous elements, which is associated with segmental destabilization and subsequent pars fracture.…”

“…1 Furthermore, presence of LSTV with spina bifida occulta (SBO) in lumbosacral junction has been frequently reported from relative reports, with the latter being also potentially identified in conjunction with isthmic spondylolisthesis (IS) in affected individuals. 2 back pain in our department. Considering the resistant to conservative treatment symptomatology in conjunction with clinical-radiologic presence of segmental instability, patient was subjected to uneventful minimally invasive lumbosacral fusion featuring complete recession of symptomatology directly postoperatively with no signs of recurrence until 6 months follow-up.…”

“…LSTV has been epidemiologically correlated with increased incidence of low back pain, with unknown to date precise pathogenetic background 1 . Furthermore, presence of LSTV with spina bifida occulta (SBO) in lumbosacral junction has been frequently reported from relative reports, with the latter being also potentially identified in conjunction with isthmic spondylolisthesis (IS) in affected individuals 2 …”

Neuromuscular scoliosis in the presence of spina bifida occulta and a transitional lumbosacral vertebra: A case report

“…found 27 (42.18%) patients (with median age of 36 years) also had SBO. Co-existence of LSTV and SBO appears to be common in patients attending for evaluation of back pain [15] . LSTV and SBO are largely asymptomatic and overlooked.…”

Building a vertebra: Development of the amniote sclerotome

“…Thus, defects in both, Tgfβ signaling and PDGFA signaling, lead to spina bifida occulta phenotypes with failed closure of the vertebral arches and loss of the spinous processes. As spina bifida malformations are of high clinical interest (Kahn et al, 2015; Sharma et al, 2022), the limited knowledge of dorsal sclerotome development urgently awaits further research work.…”