Changes of lumbosacral nerve roots innervation in lumbar disc herniation patients with transitional vertebrae / 中国组织工程研究

BACKGROUND: Lumbosacral transitional vertebra is a commonly seen congenital spinal deformity, and the changes in the muscle innervation pattern and the sensory dermatomes of the lumbosacral nerve roots have been reported, but the changes and its guidance significance for the surgeries of lumbar disc herniation have not been clarified systematically. OBJECTIVE: To explore the possibility of changes in the muscle innervation pattern and the sensory dermatomes of the lumbosacral nerve roots when there is a lumbosacral transitional vertebra. METHODS: The study was in accordance with the ethical requirements of Affiliated Hospital of Binzhou Medical University, and the subjects and their families signed the informed consents. The medical records of 321 patients with single segment lumbar disc herniation who underwent surgical treatment were analyzed retrospectively. Lumbosacral transitional vertebrae were present in 38 of 321 patients (11. 8%). There were 26 cases of sacral lumbarization and 12 cases of lumbar sacralization. Among these 26 patients with sacral lumbarization, 23 had herniated discs at L5/S1 (L6) compressing the S1 (L6) nerve root. Of the 12 patients with lumbar sacralization, 8 had herniated discs at L3/4 compressing the L4 nerve root. In the 283 normally configured patients, 138 had herniated discs at L5/S1 compressing the Si nerve root, 95 had herniated discs at L4/L5 compressing the L5 nerve root, and 47 had herniated discs at L3/L4 compressing the L4 nerve root. The preoperative symptoms of Si nerve root compression in the patients with sacral lumbarization and of L4 nerve root compression in the patients with lumbar sacralization were compared with those of L4, L5 or Si nerve root compression in the patients with normal configuration. RESULTS AND CONCLUSION: (1) The distribution of motor function depression caused by Si nerve root compression was significantly different between sacral lumbarization patients group and normal group (P < 0. 05). (2) The distribution of motor function depression caused by L4 nerve root compression was also significantly different between lumbar sacralization patients group and normal group (P < 0. 05). (3) The motor function depression caused by Si nerve root compression in sacral lumbarization patients was similar to that of the L5 nerve root compression in the normal configuration, while the motor function depression caused by L4 nerve root compression in lumbar sacralization patients was similar to that of the U nerve root compression in the normal configuration. The analysis of the sensory dermatomes also showed similar results. (4) Our results suggest that the function of lumbosacral nerve roots changes in patients with transitional vertebrae. The Si nerve roots in patients with sacral lumbarization tend to serve the usual function of L5 nerve roots (nerve roots move up), and the L4 nerve roots in patients with lumbar sacralization tend to serve the usual function of L5 nerve roots (nerve roots move down).

Advances in the study of anatomy and biomechanics of lumbosacral transitional vertebrae / 中华外科杂志

Lumbosacral transitional vertebrae (LSTV) is a common phenomena of developmental anomaly, which is characterized by anatomic variation and biomechanical changes. LSTV is often accompanied with low back pain, lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis and other spinal diseases. The diagnosis of LSTV has a great significance for proper treatment process. Early imageological studies have limitations on distinguishing different types of LSTV from the aspect of morphological changes. This review focuses on recent studies of LSTV anatomy and variation, its influence in local biomechanics and spinal alignment, and its relationship with spinal diseases.

Lumbarisation of the first sacral vertebra a rare form of lumbosacral transitional vertebra / Lumbarización de la primera vertebra sacra: rara forma de una vertebra de transición lumbosacral

In the lumbosacral region, anatomical variations occur with changes in the number of sacral vertebra either by deletion of first sacral vertebra or by the union of fifth lumbar or first coccygeal vertebra with sacrum. Lumbasacral transitional vertebrae (LSTV) is the most common congenital anomalies of the lumbosacral region. It most commonly involves the fifth lumbar vertebra showing signs of fusion to the sacrum known as sacralisation or the first sacral vertebra shows signs of transition to a lumbar configuration commonly known as lumbarisation. Complete transition can result in numerical abnormalities of the lumbar and sacral vertebral segments. Lumbarisation of first sacral vertebra is seen with a very low incidence of 2%. Knowledge of presence of such vertebral variation will be helpful for the clinicians to diagnose and treat patients with low back pain. Although sacralisation of fifth lumbar vertebrae is most commonly seen when compared to lumbarisation of first sacral vertebrae, we report here a case of lumbarisation of first sacral vertebrae for its rarity among the LSTV and clinical implications.

En la región lumbosacra, las variaciones anatómicas se basan en cambios en el número de las vértebras sacras, ya sea por ausencia de la primera vértebra sacra o por unión de la quinta lumbar o primera vértebra caudal con el sacro. Las vértebras de transición lumbasacra (VTLS) son las anomalías congénitas más frecuentes de la región lumbosacra. La VTLS más común se produce a nivel de la quinta vértebra lumbar, con signos de fusión al sacro, proceso conocido como sacralización; mientras que la primera vértebra sacra también puede mostrar signos de transición a una configuración lumbar. A esto último se lo denomina lumbarización. La transición completa puede provocar anomalías numéricas a nivel de los segmentos vertebrales lumbares y sacros. La lumbarización de la primera vértebra sacra se observa con una incidencia muy baja, de solo 2%. El conocimiento de la presencia de dicha variación vertebral será de utilidad para los médicos al momento de diagnosticar y tratar a los pacientes con dolor en la parte baja de la espalda. Aunque la sacralización de la quinta vértebra lumbar se produce más frecuentemente en comparación con la lumbarización de la primera vértebra sacra, se presenta aquí un caso de lumbarización de la primera vértebra sacra, rara entre las VTLS, y con implicaciones clínicas.

Are Spinal or Paraspinal Anatomic Markers Helpful for Vertebral Numbering and Diagnosing Lumbosacral Transitional Vertebrae?

OBJECTIVE: To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. MATERIALS AND METHODS: Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. RESULTS: The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. CONCLUSION: The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.

A forensic case of sacralization of the sixth lumbar vertebra in skeletal remains.

Lumbosacral transitional vertebrae (LSTVs) are a common congenital anomaly of the spine. In the present case, we observed LSTVs in the excessive (sixth lumbar) vertebra. In forensic practice, this anomaly may be useful for personal identification of skeletal remains.