Relationship of sacral articular surfaces and gender with occurrence of lumbosacral transitional vertebrae

ArticleinThe spine journal: official journal of the North American Spine Society 11(10):961-5 · September 2011with5 Reads
Impact Factor: 2.43 · DOI: 10.1016/j.spinee.2011.08.007 · Source: PubMed

Research on lumbosacral transitional vertebra (LSTV) has yielded important information on the structural alterations of the sacrum associated with LSTV. Nevertheless, very little data are available on the relationship of a given type of LSTV with either a typical pattern of sacral morphology or its gender distribution in the population. To investigate the probable relationship between different variants of LSTVs with sacral morphology at the articular surfaces of the bone and the gender distribution of the anomalies in the population. Cross-sectional descriptive study involving dried human sacral bones and meta-analysis of data available related to LSTVs. Three hundred twenty sacra were screened for the presence of LSTV, the type of auricular surface, and facet joints in them. Samples were grouped against their sexes, type of the auricular surfaces present in them, the nature of facet joints, and the variety of LSTV (if present). Data on LSTV from reliable Internet databases were collected to account for the prevalence of LSTV in the population in terms of the types of the anomaly and their gender distribution. The detection rates of LSTV in the present study were similar to those observed in available literature. Accessory L5-S1 articulations and lumbarization of S1 were more commonly observed in the women. Sacralization was seen to be predominantly distributed in men. Higher auricular surfaces were associated with accessory articulations; lower auricular surfaces were present with partially separated S1 segment and in L5-S1 specimens. Morphology of the facets significantly altered in LSTV with accessory articulations. Different lumbosacral transitions share a stronger, definite, and specific patterns of relationship with certain sacral morphologies and gender. It is important to recognize the nuances of these connections so as to understand low back pain conditions in the setting of a typical sacral articular morphology or the sex of the individual.

    • "In addition, transitional lumbosacral vertebrae have been shown in other studies to be very common, but as they are H. T. Spencer (&) Á M. E. Gold Á M. T. Hresko Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115, USA e-mail: outside the region of most idiopathic scoliosis fusion cases, they are not individually classified in this present study12131415 . We hypothesized that vertebral numbering variations in the thoracolumbar region can lead to ambiguous documentation of fusion levels in AIS. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose Variation in rib numbering has been noted in adolescent idiopathic scoliosis (AIS), but its effect on the reporting of fusion levels has not been studied. We hypothesized that vertebral numbering variations can lead to differing documentation of fusion levels. Methods We examined the radiographs of 161 surgical AIS patients and 179 control patients without scoliosis. For AIS patients, the operative report of fusion levels was compared to conventional vertebral labeling from the first thoracic level and proceeding caudal. We defined normal counts as 12 thoracic (rib-bearing) and five lumbar (non-rib-bearing) vertebrae. We compared our counts with data from 181 anatomic specimens. Results Among AIS patients, 22 (14 %) had an abnormal number of ribs and 29 (18 %) had either abnormal rib or lumbar count. In 12/29 (41 %) patients, the operative report differed from conventional labeling by one level, versus 3/132 (2 %) patients with normal numbering (p < 0.001). However, there were no cases seen of wrong fusion levels based on curve pattern. Among controls, 11 % had abnormal rib count (p = 0.41) compared to the rate in AIS. Anatomic specimen data did not differ in abnormal rib count (p = 1.0) or thoracolumbar pattern (p = 0.59). Conclusions The rate of numerical variations in the thoracolumbar vertebrae of AIS patients is equivalent to that in the general population. When variations in rib count are present, differences in numbering levels can occur. In the treatment of scoliosis, no wrong fusion levels were noted. However, for both scoliosis patients and the general population, we suggest adherence to conventional labeling to enhance clarity.
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  • [Show abstract] [Hide abstract] ABSTRACT: The sacrum is a variable bone in its shape as well as in its relationships with the innominate bones and the fifth lumbar vertebra. Anthropologic studies classifying these variabilities have been done for over a century. Those variations can be specific to the gender or the ethnic origin of the patient. However, it can also be influenced by mechanical constraint and its adaptations. Yet, to this day, this criterion has been missing from clinical pelvic or lumbar studies; whereas this parameter could influence results and should thus be taken into account.
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