Lumbosacral transitional vertebra in a population-based study of 5860 individuals: Prevalence and relationship to low back 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.
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2022, Journal of Orthopaedic ScienceCitation 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.