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. 2012 Nov;265(2):497-503.
doi: 10.1148/radiol.12112747. Epub 2012 Sep 5.

Lumbosacral transitional vertebrae: association with low back pain

Lorenzo Nardo  1 , Hamza Alizai, Warapat Virayavanich, Felix Liu, Alexandra Hernandez, John A Lynch, Michael C Nevitt, Charles E McCulloch, Nancy E Lane, Thomas M Link
Affiliations

Lumbosacral transitional vertebrae: association with low back pain

Lorenzo Nardo et al. Radiology. 2012 Nov.

Abstract

Purpose: To assess the prevalence and degree of lumbosacral transitional vertebrae (LSTV) in the Osteoarthritis Initiative (OAI) cohort, to assess whether LSTV correlates with low back pain (LBP) and buttock pain, and to assess the reproducibility of grading LSTV.

Materials & methods: Institutional review board approval was obtained, and informed consent documentation was approved for the study protocol. Standard standing pelvic radiographs that included the transverse processes of L5 were graded according to Castellvi classification of LSTV in 4636 participants (1992 men and 2804 women; aged 45-80 years) from the OAI cohort. These data were correlated with prevalence and severity of LBP and buttock pain.

Results: Prevalence of LSTV was 18.1% (841 of 4636), with a higher rate in men than in women (28.1% vs 11.1%, respectively; P<.001). Of the 841 individuals with LSTV, 41.72% were type I (dysplastic enlarged transverse process), 41.4% were type II (pseudoarticulation), 11.5% were type III (fusion), and 5.2% were type IV (one transverse process fused and one with pseudoarticulation). Of the participants without LSTV, 53.9% reported LBP, while the prevalence of LBP for types I, II, III, and IV was 46%, 73%, 40%, and 66%, respectively (P<.05, χ2 test). Types II and IV had higher prevalence and severity of LBP and buttock pain (P<.001).

Conclusion: LSTV types II and IV positively correlate with prevalence and severity of LBP and buttock pain.

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Figures

Figure a:
Figure a:
Radiographs demonstrate the Castellvi classification of LSTV: (a) Type I: dysplastic enlarged transverse process (arrow); (b) Type II: pseudoarticulation of the transverse process with the sacrum with increased sclerosis (arrows); (c) Type III: fusion with the sacrum (arrows); (d) Type IV: unilateral LSTV type II (long arrow) with type III on the contralateral side (short arrow).
Figure b:
Figure b:
Radiographs demonstrate the Castellvi classification of LSTV: (a) Type I: dysplastic enlarged transverse process (arrow); (b) Type II: pseudoarticulation of the transverse process with the sacrum with increased sclerosis (arrows); (c) Type III: fusion with the sacrum (arrows); (d) Type IV: unilateral LSTV type II (long arrow) with type III on the contralateral side (short arrow).
Figure c:
Figure c:
Radiographs demonstrate the Castellvi classification of LSTV: (a) Type I: dysplastic enlarged transverse process (arrow); (b) Type II: pseudoarticulation of the transverse process with the sacrum with increased sclerosis (arrows); (c) Type III: fusion with the sacrum (arrows); (d) Type IV: unilateral LSTV type II (long arrow) with type III on the contralateral side (short arrow).
Figure d:
Figure d:
Radiographs demonstrate the Castellvi classification of LSTV: (a) Type I: dysplastic enlarged transverse process (arrow); (b) Type II: pseudoarticulation of the transverse process with the sacrum with increased sclerosis (arrows); (c) Type III: fusion with the sacrum (arrows); (d) Type IV: unilateral LSTV type II (long arrow) with type III on the contralateral side (short arrow).
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