Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec;11(6):892-897.
doi: 10.4184/asj.2017.11.6.892. Epub 2017 Dec 7.

Prevalence of Lumbosacral Transitional Vertebra in Individuals with Low Back Pain: Evaluation Using Plain Radiography and Magnetic Resonance Imaging

Asra Shaikh  1 , Sohail Ahmed Khan  1 , Munawar Hussain  1 , Sadia Soomro  1 , Hatem Adel  1 , Syed Omair Adil  2 , Farheen Huda  1 , Usman Khanzada  1
Affiliations

Prevalence of Lumbosacral Transitional Vertebra in Individuals with Low Back Pain: Evaluation Using Plain Radiography and Magnetic Resonance Imaging

Asra Shaikh et al. Asian Spine J. 2017 Dec.

Abstract

Study design: Descriptive cross-sectional study.

Purpose: To determine the frequency of lumbosacral transitional vertebrae (LSTV) in patients with low back pain (LBP) and the role of iliolumbar ligament (ILL) origin from L5 in LSTV cases.

Overview of literature: Transitional vertebrae are developmental variants of the spine. LSTV is a common congenital abnormality, and failure to recognize this anomaly may result in serious consequences during surgery.

Methods: All patients aged 11-90 years of either gender with LBP for any duration, who presented for X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine, were included. X-rays of the lumbosacral spine in anteroposterior and lateral views were acquired. In addition, T1- and T2-weighted sagittal and axial MRI was performed. Images were evaluated on a workstation.

Results: Of 504 patients, transitional vertebrae were observed in 75 patients (15%). Among them, 39 (52%) patients had Castellvi type III and 36 (48%) patients had Castellvi type II. However, on MRI, 42 (56%) patients had O'Driscoll type II, 18 (24%) patients had O'Driscoll type IV, and 15 patients (20%) had O'Driscoll type III. ILL origin from L5 was significantly higher (n=429, 100%) among patients with a normal lumbosacral junction than among patients with a transitional lumbosacral junction (n=22, 29.3%) (p<0.001).

Conclusions: LSTV occurs at a high frequency in patients with LBP. Furthermore, in the presence of LSTV, the ILL is not a reliable marker for the identification of L5.

Keywords: Low back pain; Lumbar vertebrae; Magnetic resonance imaging.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Comparison of transitional vertebrae with iliolumbar ligament origin from L5.
Fig. 2
Fig. 2. Magnetic resonance imaging (MRI) (A) and plain radiographs (B) of a 61-year-old female who presented with lower back pain for 4 months. (A) MRI shows lumbosacral transition vertebra (LSTV) O'Driscoll type II. Axial section through L5 shows the origin of the iliolumbar ligament from L5 (white arrows). (B) Plain radiograph shows LSTV Castellvi type II.
See this image and copyright information in PMC

References

    1. Bertolotti M. Contributo alla conoscenza dei vizi differenzazione regionale del rachide con special riguardo all assimilazione sacrale della V. Lombare. Radiol Med. 1917;4:113–144.
    1. Hsieh CY, Vanderford JD, Moreau SR, Prong T. Lumbosacral transitional segments: classification, prevalence, and effect on disk height. J Manipulative Physiol Ther. 2000;23:483–489. - PubMed
    1. Nardo L, Alizai H, Virayavanich W, et al. Lumbosacral transitional vertebrae: association with low back pain. Radiology. 2012;265:497–503. - PMC - PubMed
    1. Apazidis A, Ricart PA, Diefenbach CM, Spivak JM. The prevalence of transitional vertebrae in the lumbar spine. Spine J. 2011;11:858–862. - PubMed
    1. Weiler C, Lopez-Ramos M, Mayer HM, et al. Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index. BMC Res Notes. 2011;4:497. - PMC - PubMed

LinkOut - more resources