The clinical assessment of transitional vertebrae and back pain

Murtaugh, Karen; Kean, Walter F.

doi:10.1007/s10787-008-8011-1

Cited by 3 publications

(11 citation statements)

References 46 publications

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“…18 An in-depth clinical exam with appropriate pre-operative imaging should be combined with intra-operative monitoring and fluoroscopy to ensure that the appropriate level is identified and the correct procedure is performed. 19,20 Hughes et al, 3 in their experience with LSTV imaging, recommended the use of localizing the iliolumbar ligament for identification purposes in these patients. In our patient, we used the intra-operative O-arm for localization and guidance throughout the operation.…”

Section: Discussionmentioning

confidence: 99%

Direct lateral interbody fusion (DLIF) at the lumbosacral junction L5–S1

Shirzadi¹,

Birch²,

Drazin³

et al. 2012

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Direct lateral interbody fusion (DLIF) at the lumbosacral junction L5–S1

Shirzadi¹,

Birch²,

Drazin³

et al. 2012

Journal of Clinical Neuroscience

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“…This is an important anatomical finding in relation to numbering the lumbar spine, as review of the Iceman’s lumbar vertebra 5 (L5) shows that it is positioned lower than normal below the pelvic brim and incorporates with the sacrum to form the upper part of the sacrum. Thus, the Iceman’s L5 has assumed a transitional position between the lumbar spine proper and the sacrum (Murtagh and Kean 2008). This transitional L5 vertebra is seen in the anteroposterior lumbar X-ray view Fig.…”

Section: Resultsmentioning

confidence: 99%

“…We then observed that the L4/5 and L5/S1 disc spaces were narrow; and that the right sacroiliac joint (discussed above) was narrowed and sclerosed. These spinal and pelvic abnormalities are important clues to the clinicopathophysiological musculoskeletal conditions which may have been experienced by the Iceman (Kean et al 2004; Murtagh and Kean 2008). The condition of transitional type lumbar vertebrae with its X-ray, CT and MRI imaging findings and associated clinical features has been described by many authors over the past 90 years (Bertolotti 1917; Castellvi et al 1984; Murtagh and Kean 2008; Konin and Walz 2010).…”

Section: Discussionmentioning

confidence: 99%

The musculoskeletal abnormalities of the Similaun Iceman (“ÖTZI”): clues to chronic pain and possible treatments

Kean

Tocchio

Kean³

et al. 2012

Inflammopharmacol

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Background and IntroductionIn 1991, a deceased human male was found frozen in a glacier pool in the Italian Alps in north west Italy, and is now carefully preserved in the South Tyrol Museum of Archaeology, in Bolzano, Italy. The bodily tissues of the 5,300 year old male (colloquially referred to as the Iceman or Ötzi) were well preserved despite damage related to freezing, and glacial movement. Associated articles of well-preserved clothing, tools, weapons and other devices were also present and have been studied in detail. Clinical examination and imaging investigations have also shown that the Icemen had experienced possible illnesses in his lifetime and had identifiable areas of arthritis and musculoskeletal injury. This report includes some key observations on the musculoskeletal state of Ötzi and reference to the involvement of tattoo markings. Some aspects about the aetiology of his abnormalities and inflammatory arthritis are considered along with possible treatments that he might have employed.Methods and resultsWe (WFK and MK) undertook a clinical musculoskeletal examination of the Iceman, details of which with available photographs and radiographic imaging pertaining to the musculoskeletal findings of the Iceman are reported here. The skin of the Iceman has numerous linear carbon tattoos, which are not of a decorative type. These have been presumed to possibly be “medicinal” tattoos administered for therapeutic reasons and may have been used in acupuncture-like treatment of pain. Spinal imaging identified areas of spinal damage and our observations have provided clues as to possible sites of spinal initiated pain and hence sites for administration of the “medicinal” tattoos. We observed body areas of the Iceman, in which imaging demonstrated arthritis and other forms of long-term musculoskeletal damage, but which do not have adjacent or corresponding “medicinal” tattoos. We contend that the back and leg “medicinal” tattoos correspond directly to sites of chronic right knee and right ankle pain, and left thoracolumbar pain. They also correspond to lower lumbar and sciatic referred radicular pain which may have a contributory cause related to the presence of a transitional lumbar 5 vertebra. Using recent published data (Keller et al. in Nature Commun 3:698, 2012. doi:10.1038/ncomms1701) of the genome structure of the Iceman, we suggest some potential causes of the osteoarthritis or inflammatory joint injury may relate to presence of coronary heart disease (CHD) and Lyme disease (Borrelia burgdorferi) infection. We speculate on possible medical applications of natural products for self-medication.ConclusionsThese observations highlight several diagnostic features of musculoskeletal conditions in the Iceman with the possibility that tattoos may have been used for diagnosis or location of his painful states. The origins of his musculoskeletal conditions are unclear but there are indications that Lyme disease and CHD may have been factors. The associations or use of natural products may give insights into th...

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“…[3][4][5][6][7][8] Literatürdeki bu farklı oranlar tanı kriterleri, radyolojik görün-tüleme yöntemleri ve çalışmanın yapıldığı popü-lasyonun özelliklerine bağlı olarak değişmektedir. 8 Çalışmamızdaki oranın daha düşük bulunması; literatürde yapılmış çalışmalarla karşılaştırıldığında, olgu sayımızın yüksek olmasından kaynaklanabilir.…”

Section: Discussionunclassified

“…Bel ağrısı olanlarda GVA varlığı, medikal tedavinin şeklini değiştirmemektedir. 4 Literatürde, anestezik maddelerin ve steroidlerin lokal enjeksiyonunun uygulandığı olgulardan da bahsedilmektedir. 13 …”

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Prevalence of Coincidental Transitional Vertebrae in Routine Lumber Computerized Tomography and Magnetic Resonance Imaging

Oyar¹,

Akkoç²,

Apaydin³

et al. 2012

Turkiye Klinikleri J Med Sci

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932umbosakral bileşkenin konjenital anomalilerinden olan geçişsel vertebra anomalisi (GVA), sakralizasyon veya lumbalizasyon şeklinde gö-rülmektedir. Sakralizasyon, beşinci lomber vertebranın transvers çıkıntısının normalden fazla büyüyerek sakrum ile birleşmesi ve vertebranın sakrum özelliği kazanmasıdır. Lumbalizasyon ise birinci sakral vertebranın Rutin Lomber Bilgisayarlı Tomografi ve Manyetik Rezonans Görüntülemede Rastlantısal Geçişsel Vertebra Görülme Sıklığı Ö ÖZ ZE ET T A Am ma aç ç: : Bu makaleyle bel ağrısı nedeniyle rutin lomber vertebral bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) tetkikleri yapılmış olgularda, lumbosakral bileşkede geçişsel vertebra anomalisi görülme sıklığını ve bel ağrısı etiyolojisindeki etkinliğini araştırmak amaç-lanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Son iki yıl içinde, bel ağrısı yakınması ile başvuran ve 3,125'i lomber BT, 15,471'i lomber MRG ile incelenmiş toplam 18,595 olgu geçişsel vertebra anomalisi açısından retrospektif olarak değerlendirildi. Geçişsel vertebra anomalisi dışında bel ağrısına sebep olabilecek ek patolojiler kaydedildi B Bu ul lg gu ul la ar r: : Olguların 365'inde geçişsel vertebra anomalisi saptandı. Bunların 15'i lumbalizasyon, 350'si sakralizasyon şeklindeydi. Bu verilerin ışığında, bel ağrısı yakınması nedeniyle yapılan lomber vertebral BT ve MRG tetkiklerinde geçişsel vertebra anomalisi görülme sıklığı %1,9 olarak bulundu. S So on nu uç ç: : Bel ve siyatik ağrı şikayeti ile lomber BT ya da MRG tetkiki yapılan olgularda lumbosakral bileşke geçişsel vertebra anomalisi yönünden dikkatlice incelenmeli, ağrıya sebep olabilecek ek bir patoloji yoksa ağrının sebebinin geçişsel vertebra anomalisi olabileceği göz önünde bulundurulmalıdır.A An na ah ht ta ar r K Ke el li im me el le er r: : Sırt ağrısı; etiyoloji A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : This study was aimed to investigate the prevalence of transitional vertebrae abnormality in lumbosacral junction and its place in low back pain etiology in the patients who had lumber vertebral computerized tomography (CT) and magnetic resonance imaging (MRI) due to low back pain. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A total of 18.595 cases who applied to the hospital with the complaint of low back pain of whom 3.125 were examined with lumber CT and 15.471 were examined with MRI were evaluated retrospectively in terms of transitional vertebrae abnormalities. Additional pathologies except for transitional vertebrae abnormality that may cause low back pain were recorded. R Re es su ul lt ts s: : Transitional vertebrae abnormalities were detected in 365 patients; 30 sacralizations and 15 were lumbalizations. MRI and CT showed that the prevalence of the transitional vertebrae abnormality in the patients with low back pain wass 1.9%. C Co on nc cl lu us si io on n: : Lumbosacral junction should be examined carefully in the cases who had vertebral CT or MRI performed due to low back or sciatic pain complaints in terms of transit...

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The clinical assessment of transitional vertebrae and back pain

Cited by 3 publications

References 46 publications

Direct lateral interbody fusion (DLIF) at the lumbosacral junction L5–S1

Direct lateral interbody fusion (DLIF) at the lumbosacral junction L5–S1

The musculoskeletal abnormalities of the Similaun Iceman (“ÖTZI”): clues to chronic pain and possible treatments

Prevalence of Coincidental Transitional Vertebrae in Routine Lumber Computerized Tomography and Magnetic Resonance Imaging

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