A STUDY ON LUMBOSACRAL TRANSITIONAL VERTEBRA (LSTV) AND ITS SIGNIFICANCE IN LUMBAR DISC SURGERY.

Dr. T. P. Jeyaselva senthilkumar, Dr. I. Mohamed abith ali, Prf. C. Sekar

Abstract


Introduction: Lumbosacral transitional vertebra (LSTV) is a congenital spinal anomaly defined as either sacralization of lumbar segment or
lumbarization of sacral segment of the spine. Inaccurate identification of LSTV may lead to wrong level disc surgery with resultant failed back
syndrome.
Aim: To analyse the incidence, age & sex distribution of LSTV in low back pain patients. To analyse the intraoperative measures to avoid
wrong level surgery in LSTV patients.
Materials & methods: This study was done prospectively in 244 cases admitted with lowback pain and underwent surgery for lumbar disc
prolapse in a tertiary care hospital near Chennai. Pre op evaluation done to identify LSTV, intra op C-arm and correlation with pre op image to
identify correct level for surgery. Post op image to confirm correct level surgery was done for all cases.
Conclusion: The reliability of combined radiological methods (x ray LS spine with D12, MRI sagittal to count from c2, MRI axial to look for
iliolumbar ligaments ) to identify LSTV is 100%. Intra operative image guidance with C arm and correlation with preop imaging will reduce the
Surgical error to 0 %.


Full Text:

PDF

References


Malanga GA, Cooke PM. Segmental anomaly leading to wrong level disc surgery in cauda equina syndrome. Pain Physician 2004; 7: 107-110.

Bressler EL. Numbering of lumbosacral transitional vertebrae on MRI. AJR Am J Roentgenol 2007;188:W210.

Delport EG, Cucuzzella TR, Kim N, Marley J, Pruitt C, Delport AG. Lumbosacral transitional vertebrae : incidence in a consecutive patient series. Pain Physician 2006; 9: 53-56.

Tini PG, Wieser C, Zinn WM. The transitional vertebra of the lumbosacral spine: its classification, incidence, prevalence, and clinical significance. Rheumatol Rehabil 1977;16:180–85

Tabor ML. Statistical study of anomalies of the lumbar and lumbosacral vertebrae: radiologic findings from 7,500 orthopedic patients [in French]. J Radiol Electrol Med Nucl 1968;49:713–18

Vergauwen S, Parizel PM, van Breusegem L, et al. Distribution and incidence of degenerative spine changes in patients with a lumbo-sacral transitional vertebra. Eur Spine J 1997;6:168–72

Kim YH, Lee PB, Lee CJ, et al. Dermatome variation of lumbosacral nerve roots in patients with transitional lumbosacral vertebrae. Anesth Anelg 2008;106:1279–83

Wigh RE, Anthony HF Jr. Transitional lumbosacral discs: probability of herniation.Spine 1981;6:168–71

Aihara T, Takahashi K, Ogasawara A, Itadera E, Ono Y, Moriya H. Intervertebral disc degeneration associated with lumbosacral transitional vertebrae : a clinical and anatomical study. J Bone Joint Surg 2005 ; 87-B : 687- 691.

O’Driscoll CM, Irwin A, Saifuddin A. Variations in morphology of the lumbosacral junction on sagittal MRI: correlation with plain radiography. Skeletal Radiol 1996;25:225–30.

Elster AD. Bertolotti’s syndrome revisited: transitional vertebrae of the lumbar spine. Spine 1989;14:1373–77

Luoma K, Vehmas T, Raininko R, et al. Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine 2004;29:200–05

Hahn PY, Strobel JJ, Hahn FJ. Verification of lumbosacral segments on MR images: identification of transitional vertebrae. Radiology 1992;182:580–81.

Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol 2006;187:W59–W65.


Refbacks

  • There are currently no refbacks.