The transitional lumbosacral osseous complex.

The weight of the head and trunk is transferred to the lower extremities through that segment of the spine articulating either directly or indirectly with the ilii. When a lumbosacral transitional vertebra is present the position of the weight-bearing platform usually changes. A bony entity is formed delineated superiorly by the top of the transitional vertebra and inferiorly by the lower level of the sacroiliac joints. This segment is designated as the transitional lumbosacral osseous complex. Measurements of its length in the three phylogenetic categories in man, including measurements of the articulating portion of the sacrum in the human mode, showed a range of 68 mm to 157 mm and variations from 2.0 to 3.7 in vertebral lengths.

Transitional lumbosacral discs. probability of herniation.

The charts and roentgenograms of 200 patients operated upon for lumbar disc herniations were reviews. Among them, there were 42 persons in whom a lumbosacral transitional vertebra existed. The discs beneath these vertebra varied in appearance. A descriptive classification for the four disc types is proposed. In none of the 42 patients were there myelographic evidence of herniation of such a disc. In five instances, such disc were surgically inspected, and no protrusion was uncovered. Before transitional discs are operated upon, the proof of herniation should be incontrovertible.

The thoracolumbar and lumbosacral transitional junctions.

Correct dermatome identification is essential to reduce nomenclature and surgical errors, to improve neurologic correlation, and to produce accurate statistics regarding low-back problems. The phylogenetic category of the spine must be known and junctional transitional vertebrae within the column properly identified and localized. This article emphasizes the appearances of, and the different positions of, transitional vertebrae at the thoracolumbar and lumbosacral junctions in the vertebral sequence depending on the phylogenetic category of the patient. It describes three additional characteristics of these anomalous vertebrae. Suggestions are made to eliminate the confusion and mistakes produced by the presence of these frequent variants.

Phylogeny and the herniated disc.

Using a phylogenic classification of the spine, one can identify precisely the numerical location of any vertebra or disc, including vertebrae with junctional anomalies at transitional zones. Such precision permitted comparisons of myelographic reports of sites of disc disease with the actual levels of extradural deformities and of charted levels of disc operations with the actual levels of disc curettements. Among 100 patients there were 33 with phylogenic or junctional departures from the human mode. Among these 33 there was a combined total of 18 identification errors, and there were four entries at incorrect levels. Preoperative landmarking would appear to be obligatory.

On defining microcardia: application in pulmonary emphysema.

Pulmonary emphysema was the disease entity from which we derived a definition for microcardia in males. After the fourth decade, a cardiothoracic ratio of 38% or less is considered to represent a small heart. Among male Veterans Hospital patients between the ages of 41 and 83, the probability of an individual without emphysema having a cardiothoracic ratio of 38% or less was under 1%. Microcardia, even as an isolated sign, should make one suspect strongly the presence of subclinical emphysema and to consider instituting a prophylactic regimen. Hearts should be measured to judge not only increased size but decreased size in both patient and examinee groups.

Duodenal crypts.

During the course of 2,340 barium examinations of the upper gastrointestinal tract, four male patients were found to have multiple small outpouchings on the surface of the duodenal bulb. These findings, designated duodenal crypts, are considered to be asymptomatic and are not to be confused with inflammatory changes. The endoscopic and roentgenologic appearances are illustrated.

Duodenal crypts.

During the course of 2,340 barium examinations of the upper gastrointestinal tract, four male patients were found to have multiple small outpouchings on the surface of the duodenal bulb. These findings, designated duodenal crypts, are considered to be asymptomatic and are not to be confused with inflammatory changes. The endoscopic and roentgenologic appearances are illustrated.