Lumbosacral transitional segments: Classification, prevalence, and effect on disk height

Hsieh, Chang-Yu J.; Vanderford, Jason D.; Moreau, Susan R.; Prong, Tzerlin

doi:10.1067/mmt.2000.108817

Cited by 57 publications

(47 citation statements)

References 5 publications

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“…2-4,8,9,12,13,15-28 Although not initially described, the low back pain of this syndrome is currently thought to be of varying etiologies, subsequently arising from different locations: 1) disk, spinal canal, and posterior element pathology at the level above a transition 5,8,9,12,20,24,31 ; 2) degeneration of the anomalous articulation between an LSTV and the sacrum; 3) facet joint arthrosis contralateral to a unilateral fused or articulating LSTV 30,32 ; and 4) extraforaminal stenosis secondary to the presence of a broadened transverse process (Figs 13-16). 12,29 -31,38 In most of the literature that supports Bertolotti syndrome, the implicated transitional segments are Cas- Transitional S1 vertebral body in a 52-year-old woman.…”

Section: Bertolotti Syndromementioning

confidence: 99%

“…Additionally, although the relationship of low back pain and LSTV, termed "Bertolotti Syndrome," has been debated in the literature since its initial description in 1917, many support this association. [2][3][4]8,9,12,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28] Symptoms can originate from the anomalous articulation itself, the contralateral facet joint (when unilateral), instability and early degeneration of the level cephalad to the transitional vertebrae, and nerve root compression from hypertrophy of the transverse process. 2,3,5,8,9,12,20,24,[29][30][31] The symptoms associated with each of the above processes are treated differently, requiring reliable techniques to not only identify LSTVs but also determine the type and site of the pathology generated by the transitional segment.…”

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confidence: 99%

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Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Konin

Walz²

2010

AJNR Am J Neuroradiol

290

262

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SUMMARY:LSTVs are common within the spine, and their association with low back pain has been debated in the literature for nearly a century. LSTVs include sacralization of the lowest lumbar vertebral body and lumbarization of the uppermost sacral segment. These vertebral bodies demonstrate varying morphology, ranging from broadened transverse processes to complete fusion. Low back pain associated with an LSTV may arise from the level above the transition, the contralateral facet when unilateral, and/or the anomalous articulation when present. Although this association is still somewhat controversial, beyond dispute is the importance of identifying an LSTV in patients in whom a surgical or interventional procedure is planned. This is essential to avoid an intervention or surgery at an incorrect level. In this article, each of these issues will be addressed with attention to identifying and correctly numbering LSTVs as well as detecting imaging findings related to the genesis of low back pain.ABBREVIATIONS: AP ϭ anteroposterior; LSTV ϭ lumbosacral transitional vertebra L STVs are congenital spinal anomalies defined as either sacralization of the lowest lumbar segment or lumbarization of the most superior sacral segment of the spine. LSTVs are common in the general population, with a reported prevalence of 4%-30%.1-15 The degree of morphologic variation of these segments ranges from L5 vertebrae with broadened elongated transverse processes to complete fusion to the sacrum. Conversely, the S1 vertebral segment can show varying degrees of lumbarization, such as the formation of an anomalous articulation rather than fusion to the remainder of the sacrum, well-formed lumbar-type facet joints, a more squared appearance in the sagittal plane, as well as a well-formed fully-sized disk, rather than the smallersized disk typically seen between S1 and S2.

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Section: Bertolotti Syndromementioning

confidence: 99%

mentioning

confidence: 99%

Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Konin

Walz²

2010

AJNR Am J Neuroradiol

290

262

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“…One or both transverse processes is (are) dysplastic (also called spatulated), measuring at least 19 mm in width. This is an atypical version of an otherwise normal lumbar segment 9,21 (Figure 1).…”

Section: Classification Of Ltvmentioning

confidence: 99%

Use of Lumbosacral Region Manipulation and Therapeutic Exercises for a Patient With a Lumbosacral Transitional Vertebra and Low Back Pain

Brenner¹

2005

J Orthop Sports Phys Ther

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Study Design: Case report. Background: A lumbosacral transitional vertebra (LTV) is a congenital anomaly that occurs in 3% to 21% of people with and without low back pain (LBP). There is lack of agreement in the literature as to whether or not the presence of a LTV may cause LBP. The objective of this case report is to present the use of lumbosacral region manipulation and therapeutic exercises on a patient with a known LTV and LBP. Case Description: In this case report, an active-duty US Army soldier was referred to physical therapy with right-sided LBP and a lumbar radiograph showing a hemisacralized transitional L5 vertebra on the same side as his pain. The patient was treated with lumbosacral region manipulation and flexion exercises aimed at regaining total spinal motion and reducing pain. The patient responded favorably to spinal manipulation and exercise and was discharged from physical therapy after 4 visits. A modified Oswestry Low Back Pain Disability Questionnaire and inclinometer were used to measure outcome after physical therapy intervention. Outcomes: After a 2-week period of treatment in physical therapy, the patient improved from an initial Oswestry score of 32% to a score of 4%. Forward bending and left side bending improved from 74°to 140°and from 21°to 45°, respectively. Discussion: Lumbosacral region manipulation along with therapeutic exercises appears to have been an effective treatment approach for this patient with LBP associated with a type IIA LTV. J Orthop Sports Phys Ther 2005;35:368-376.

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“…12 A review of the literature suggests that LSTV anomalies occur in approximately 7% of the population, 12 although there are few documented cases. 10,[12][13][14] One case report 15 describes a case of partial transitional lumbosacral vertebrae presenting as a Castellvi 16 type IIb variant, where an accessory articulation was formed bilaterally between the elongated transverse processes (TVPs) of L5 and the sacrum, although links between congenital variations and back pain are not clear. Unilateral sacralization, termed by Castellvi as type IIIa variants, has been documented in the literature.…”

Section: Introductionmentioning

confidence: 99%

Partial lumbosacral transitional vertebrae: 2 cases of unilateral sacralization

Muir

2012

Journal of Chiropractic Medicine

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Objective: Lumbosacral transitional vertebrae (LSTV) are relatively common skeletal anomalies with a debated role in low back pain. There are few documented cases of conservative care being used to address LSTV-associated symptomatology. The current report discusses chiropractic management of 2 patients with unilateral sacralization. Clinical Features: Two patients with LSTV involving unilateral sacralization of L5, a Castellvi type IIIa variant, presented with back pain to a chiropractic clinic. Each case presented with symptomatology similar to piriformis syndrome. Intervention and Outcome: Manual therapy, including spinal manipulation soft tissue therapies and exercise/stretching, was used to address the presenting symptoms. Approximately 2 weeks after initial treatment, the first patient subjectively reported a 70% improvement in symptoms, with lumbar extension increased to full in active range of motion at the lumbar spine but with continued tenderness and hypertonicity at the left piriformis and gluteus medius. After 4 weeks of treatment, the second patient reported improvement in pain and perceived mobility, although prolonged standing remained an aggravating factor. Although both showed improvement, neither case resulted in complete resolution of symptoms. Conclusion:The presenting cases demonstrated partial resolution of symptoms after chiropractic management. It is proposed that sacralization is a possible cause of back pain in these cases.

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Lumbosacral transitional segments: Classification, prevalence, and effect on disk height

Cited by 57 publications

References 5 publications

Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Use of Lumbosacral Region Manipulation and Therapeutic Exercises for a Patient With a Lumbosacral Transitional Vertebra and Low Back Pain

Partial lumbosacral transitional vertebrae: 2 cases of unilateral sacralization

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