Associations between lumbosacral transitional anatomy types and degeneration at the transitional and adjacent segments

Abstract Background context The relation between specific types of lumbosacral transitional vertebra and the degree of degeneration at and adjacent to the transitional level is unclear. It is also unknown whether the adjacent cephalad segment to a transitional vertebra is prone to greater degenerati...

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Bibliographic Details
Published in:The spine journal 2015-06, Vol.15 (6), p.1210-1216
Main Authors: Farshad-Amacker, Nadja A., MD, Herzog, Richard J., MD, Hughes, Alexander P., MD, Aichmair, Alexander, MD, Farshad, Mazda, MD, MPH
Format: Article
Language:English
Subjects:
Adult
Aged
Disc degeneration
Female
Humans
Intervertebral Disc Degeneration - pathology
Intervertebral Disc Displacement - pathology
LSTV
Lumbar Vertebrae - pathology
Lumbosacral anomalies
Lumbosacral Region - pathology
Lumbosacral transitional vertebra
Magnetic Resonance Imaging
Male
Middle Aged
Orthopedics
Retrospective Studies
Sacrum - pathology
Spine transitional anomalies
Transitional vertebra
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Summary:Abstract Background context The relation between specific types of lumbosacral transitional vertebra and the degree of degeneration at and adjacent to the transitional level is unclear. It is also unknown whether the adjacent cephalad segment to a transitional vertebra is prone to greater degeneration than a normal L5–S1 level. Purpose The purpose of this study was to evaluate the relation between specific lumbosacral transitional vertebra subtypes according to the Castellvi classification, and to determine the severity of degeneration at the transitional level and the adjacent cephalad segment. Study design This study was a retrospective review. Patient samples Ninety-two subjects with lumbosacral transitional vertebra grade 2 or higher and 94 control subjects without were retrieved from a picture archiving and communication system (PACS) search. Outcome measures Disc degeneration parameters at the transitional and at the adjacent cephalad level were measured. Methods After institutional review board approval, 92 subjects (42 men; mean age, 57±16 years) with lumbosacral transitional vertebra grade 2 or higher and 94 control subjects (41 men; mean age, 51±16 years) without were retrieved from a PACS search. Degeneration of the last two segments of the lumbar spine was quantified using the Pfirrmann and Modic classifications, along with documentation of annular tears, disc herniations, and disc height, and were compared between the two groups. Furthermore, L5–S1 levels in the control subjects were compared with the adjacent cephalad segments of the transitional vertebrae for the same parameters. Results Although the control subjects, at L5–S1, had moderate to severe degeneration by Pfirrmann grades (31%) and Modic changes ([MC] 20%), in comparison, the discs at the transitional level of the lumbosacral transitional vertebra group demonstrated significant less degeneration (3% and 1%, respectively; each p
ISSN:1529-9430
1878-1632
DOI:10.1016/j.spinee.2013.10.029