Evaluation of spinal-paraspinal parameters to determine segmentation of the vertebrae

Peker, Elif; Hürsoy, Nur; Akkaya, Habip Eser; Ünal, Sena; Gülpınar, Başak; Arıkan, Bilgesu; Anamurluoglu, Ezgi; Erden, İlhan

doi:10.5114/pjr.2019.90227

Cited by 1 publication

(5 citation statements)

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“…LSTV are common congenital anomalies ( 1 , 2 ). However, only a whole spinal image could detect a complete LZ and allow differentiation between type I LZ and type I sacralization.…”

Section: Discussionmentioning

confidence: 99%

“…However, only a whole spinal image could detect a complete LZ and allow differentiation between type I LZ and type I sacralization. If only a lumbar MRI was performed, it was impossible to determine the correct segmentation in 6.2% of the LSTV group ( 1 ). Full LZ might be misdiagnosed as normal spinal sequence, and confusion between type I LZ and type SZ might occur, which might result in confusion between true (type I LZ) and “forme fruste” LSTV (type I sacralization).…”

Section: Discussionmentioning

confidence: 99%

“…Whole spinal images help detect the existence of type I LZ without incorrect level numbering. When only lumbar images were present, segments might be incorrectly considered in as high as 11% of cases ( 1 ). Some defined the penultimate free disc level as designation L4/5, which might be real L5S1 in complete lumbarization cases ( 4 ) or real L3/4 in complete sacralization cases ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…It was said that in the presence of LSTV, normal vertebral biomechanics are impaired due to the deterioration of the anatomy. Consequently, instability and early disc degeneration are observed ( 1 ). Our patient belonged to type I LZ with type IV LSTD, and no instability was observed.…”

Section: Discussionmentioning

confidence: 99%

“…A normal spine contains seven cervical, 12 thoracic, and five lumbar vertebrae ( 1 ). Lumbosacral transitional vertebra (LSTV) is defined as either lumbarization (LZ) of the highest sacral spinal segment or sacralization of the most inferior lumbar spinal segment.…”

Section: Introductionmentioning

confidence: 99%

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Complete lumbarization with calcified disc herniations at L5S1 and S1-2 levels treated with percutaneous endoscopic interlaminar discectomy: a case report and technique note

et al. 2023

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ObjectiveThis study aims to report a case of a patient with complete lumbarization (Castellvi-IB) who developed symptomatic calcified disc herniations at L5S1 and lumbarized S1-2 levels and achieved excellent neurological recovery following percutaneous endoscopic interlaminar discectomy (PEID).Summary of Background DataIn 1984, Castellvi et al. classified lumbosacral transitional vertebra (LSTV) into four types. They incorrectly classified I LSTV anomalies as only type I sacralization, not realizing type I lumbarization also belonged to type I LSTV, with the latter exhibiting a well-developed S1-2 disc (lumbosacral transitional disc, LSTD). Patients with type I lumbarization rarely develop calcified disc herniations concomitantly at L5S1 and LSTD levels. PEID has been developed to perform discectomy for neurological decompression at the lumbar region, especially at the lowest level where the higher iliac crest and/or widened transverse process exists.MethodsA 47-year-old male presented to our hospital complaining of an intractable left leg radiating pain for 3 weeks after suffering from chronic radiating pain for 4 years. His physical examination found hyperalgesia at the lateral side of the left calf, decreased dorsal flexion strength of the ankle (grade 4/5), and a positive sign of straight leg raising test at the left side (30°). The preoperational Lumbar JOA (Japanese Orthopaedic Association) score was 12. Image examinations including whole spinal radiograph, MRI, and CT confirmed complete lumbarization (Castellvi-IB) with calcified disc herniations at L5S1 and LSTD levels at the left side. PEID was carried out at two index levels to accomplish decompression via the left approach.ResultsThe patient’s neurological function recovered quickly. One day postoperatively, he began to walk without discomfort. After 3 months, his muscle strength recovered to normal, and after 6 months, the residual dysesthesia at his posterolateral calf disappeared. The follow-up Lumbar JOA score was 26.ConclusionCalcified lumbar disc herniation could develop at two distal levels concomitantly in the case of type I complete lumbarization. This anomaly might be misinterpreted as a normal lumbar sequence by only lumbar MRI. PEID may be an effective procedure to treat such calcified disc herniations in a single visit.

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“…LSTV are common congenital anomalies ( 1 , 2 ). However, only a whole spinal image could detect a complete LZ and allow differentiation between type I LZ and type I sacralization.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%