Elsevier

European Journal of Radiology

Volume 83, Issue 9, September 2014, Pages 1679-1682
European Journal of Radiology

Lumbosacral transitional vertebra in a population-based study of 5860 individuals: Prevalence and relationship to low back pain

https://doi.org/10.1016/j.ejrad.2014.05.036Get rights and content

Abstract

Purpose

To investigate the prevalence of lumbosacral transitional vertebra (LSTV) within the Chinese Han population, and to determine whether LSTV correlates with low back pain (LBP) and gluteal pain.

Materials and methods

Typical standing pelvic radiographs were obtained for 5860 volunteers between 18 to 60 years of age. The lumbosacral region of each spine was evaluated to identify LSTV, which was classified into types I, II, III, and IV based on Castellvi's method. Histories of low back symptoms were obtained using a questionnaire. The association of different subtypes of LSTV with LBP and gluteal pain was explored.

Results

LSTV was found in 15.8% (928 of 5860) of our study population. Of the 928 individuals with LSTV, 44.8% were type I (dysplastic transverse process with height >19 mm), 43.2% were type II (pseudoarticulation), 7.2% were type III (fusion), and 4.8% were type IV (a unilateral type II transition with a type III fusion on the contralateral side). Type II LSTV were closely associated with LBP and gluteal pain, with respective odds ratios (ORs) of 2.56 (95% CI: 2.17–3.89) and 5.38 (95% CI: 4.29–8.43). Similarly, types IV LSTV also demonstrated a significant correlation with LBP and gluteal pain, with respective ORs of 4.28 (95% CI: 3.21–6.35) and 6.82 (95% CI: 5.17–16.59).

Conclusions

In this population-based study, the prevalence of LSTV was 15.8%, with type I being the most common. Importantly, LSTV types II and IV were significantly associated with LBP and gluteal pain.

Introduction

Lumbosacral transitional vertebra (LSTV), a common congenital anomaly first observed by Bertolotti in 1917, is defined as a total or partial unilateral or bilateral fusion of the enlarged transverse process of the lowest lumbar vertebra to the sacrum [1], [2]. Abnormal biomechanics associated with asymmetric transitional vertebra has been suggested to cause pain on the side of the anomalous articulation [3], [4] or on the opposite side [5]. However, whether such an anatomical variation produces low back pain (LBP) and/or sciatica has been a subject of great debate. Some authors believe that the LSTV could cause symptoms of back pain and/or sciatica [3], [6], [7], whereas others claim that this abnormal vertebra does not affect their incidence [4]. Therefore, further studies focusing on the relationship between LSTV and LBP are needed to reach a conclusion. To date, there are only two large-scale studies of LSTV in the adult population [8], [9]. However, these two studies were not carried out in the general population, and therefore may not reflect the true prevalence of LSTV.

A systematic study of LSTV in the lumbosacral region among the general population can provide fundamental epidemiologic insights regarding LSTV and an important reference for clinical observations. The primary purpose of the present study was to identify the prevalence of LSTV using a large population-based sample. Additionally, we also investigated the association of the different subtypes of LSTV with LBP and gluteal pain.

Section snippets

Subjects

The local ethics committee approved the study and informed consent was obtained. The maximum number of patients and the time span of study inclusion were defined in our ethic committee proposal. We performed a power analysis using Quanto software. The results showed a power value of 0.89 using a prevalence of LSTV in other populations of 4% [3], [8]. Additionally, the number of patients was calculated. Following this, a prospective study was performed. Volunteers of Chinese Han origin, aged

Results

It was found that 15.8% (928 of 5860) of our study population presented with LSTV – 17.6% (567 of 3217) of men (mean age, 40.6 ± 19.2, range, 18–58 years) and 13.7% (361 of 2643) of women (mean age, 41.1 ± 22.5, 21–60 years) (P > 0.05) (Table 2). In addition, no significant difference regarding ORs for clinical symptoms was observed between male subjects with LSTV and female subjects with LSTV (Table 3). Of note, LSTV presence did not vary with age (Fig. 2). According to Castellvi classification of

Reproducibility analysis

The Cohen k value for interobserver agreement on the presence or absence of LSTV in the entire cohort was 0.86. The Cohen k value for intraobserver agreements for the two radiologists in a set of 2000 randomly selected radiographs were 0.82 and 0.91. The Cohen k value for interobserver agreement using the categorical Castellvi classification was 0.72, and the values for intraobserver agreement were 0.69 and 0.77. These values were classified as good reader agreement.

Discussion

To our knowledge, this is the largest population study and the first study that addresses the prevalence of LSTV within the Chinese Han population.

LSTV is a common condition in the adult population, with a wide variability in the reported prevalence, ranging from 4.0% to 36% [3], [8], [10], [11], [12], [13]. The source of this variability is related to the fact that these studies have suffered from deficiencies including relatively small samples [4], [6], narrow age spans [7], limited

Conflict of interest

The authors declare that they have no conflicts of interest.

References (22)

  • A. Apazidis et al.

    The prevalence of transitional vertebrae in the lumbar spine

    Spine J

    (2011)
  • C.Y. Hsieh et al.

    Lumbosacral transitional segments: classification, prevalence, and effect on disk height

    J Manipulative Physiol Ther

    (2000)
  • R.J. Hughes et al.

    Imaging of lumbosacral transitional vertebrae

    Clin Radiol

    (2004)
  • M. Bertolotti

    Contribute alla conoscenza dei vizi di differenzazione delrachide con speciale reguardo all assimilazione sacrale della v lombare

    Radiol Med

    (1917)
  • A. Castellvi et al.

    Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects

    Spine

    (1984)
  • J. Brault et al.

    Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain

    Spine

    (2001)
  • K. Luoma et al.

    Lumbosacral transitional vertebra relation to disc degeneration and low back pain

    Spine

    (2004)
  • K. Kikuchi et al.

    Anterior decompression for far-out syndrome below a transitional vertebra: a report of two cases

    Spine J

    (2013)
  • J.F. Quinlan et al.

    Bertolotti's syndrome. A cause of back pain in young people

    J Bone Joint Surg Br

    (2006)
  • L. Nardo et al.

    Lumbosacral transitional vertebrae: association with low back pain

    Radiology

    (2012)
  • P.G. Tini et al.

    The transitional vertebra of the lumbosacral spine: its radiological classification, incidence, prevalence, and clinical significance

    Rheumatol Rehabil

    (1977)
  • Cited by (78)

    • The incidence of congenital lumbosacral malformations in young male Turkish military school candidates population

      2022, Journal of Orthopaedic Science
      Citation Excerpt :

      SBO is defined as fusion failure between posterior vertebral elements of the lumbosacral region without affecting the spinal cord and meninges [6]. The lumbosacral transition vertebra is defined as a total or partial unilateral or bilateral fusion of the enlarged transverse process of the lowest lumbar vertebra to the sacrum [4,7]. Another important point of radiographically detected lumbar region anomalies, apart from pain, is that surgeries performed at the wrong level are reported because of incorrect definition of vertebral levels.

    View all citing articles on Scopus
    View full text