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Spinopelvic alignment and sagittal balance of asymptomatic adults with 6 lumbar vertebrae

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Abstract

Purpose

The purpose of this study was to evaluate total spinal alignment in asymptomatic individuals with 6 lumbar vertebrae (LVs).

Methods

The present study comprised 167 Japanese adult volunteers with no spinal symptoms. In all individuals, standing radiographs of the entire spine were taken to measure the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), C7 sagittal vertical axis (C7SVA), T1 slope, thoracic kyphosis (TK), C2–C7 sagittal vertical axis (C2–C7 SVA), and C2–C7 lordosis (C2–C7L). We used these parameters to compare individuals with 5LVs to those with 6LVs. We performed additional investigations regarding the relationship between L6 morphological characteristics and parameters.

Results

Out of 167 individuals, 6LVs were present in 29 (17.4 %). PI was significantly greater in individuals with 6LVs (64.8° ± 9.54°) than in those with 5LVs (51.3° ± 10.1°, P < 0.0001). Individuals with 6LVs also had significantly larger SS, PT, and C7SVA values (SS: P = 0.0125, PT: P < 0.0001, C7SVA: P = 0.0172). LL tended to be nonsignificantly greater in individuals with 6LVs (P = 0.1588). All of these changes were more noticeable in individuals in whom the L6 vertebra was classified as type II and III according to the Castellvi classification. Meanwhile, the presence of 6LVs has little influence on the alignment of the superior lumber vertebrae.

Conclusions

Asymptomatic individuals with 6LVs presented with different spinopelvic alignment compared to those with 5LVs. We need to establish a treatment strategy for symptomatic 6LV cases.

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Abbreviations

LVs:

Lumbar vertebrae

LSTV:

Lumbosacral transitional vertebra

LBP:

Low back pain

PI:

Pelvic incidence

SS:

Sacral slope

PT:

Pelvic tilt

LL:

Lumbar lordosis

C7SVA:

C7 sagittal vertical axis

TK:

Thoracic kyphosis

C2–C7SVA:

C2–C7 sagittal vertical axisx

C2–C7L:

C2–C7 lordosis

References

  1. Castellvi AE, Goldstein LA, Chan DP (1984) Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine 9:493–495

    Article  CAS  PubMed  Google Scholar 

  2. Konin GP, Walz DM (2010) Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol 31(10):1778–1786

    Article  CAS  PubMed  Google Scholar 

  3. Paik NC, Lim CS, Jang HS (2013) Numeric and morphological verification of lumbosacral segments in 8280 consecutive patients. Spine 38(10):E573–E578

    Article  PubMed  Google Scholar 

  4. Sekharappa V, Amritanand R, Krishnan V et al (2014) Lumbosacral transition vertebra: prevalence and its significance. Asian Spine J 8(1):51–58

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tang M, Yang XF, Yang SW et al (2014) Lumbosacral transitional vertebra in a population-based study of 5860 individuals: prevalence and relationship to low back pain. Eur J Radiol 83(9):1679–1682

    Article  PubMed  Google Scholar 

  6. Elster AD (1989) Bertolotti’s syndrome revisited. Transitional vertebrae of the lumbar spine. Spine 14(12):1373–1377

    Article  CAS  PubMed  Google Scholar 

  7. Bertolloti M (1917) Contribution to the knowledge of the defects of regional differentiation of the vertebral column with special attention to the fusion of the fifth lumbar vertebra to the sacrum [in Italian]. Radiologique Med 4:113–144

    Google Scholar 

  8. Brault JS, Smith J, Currier L (2001) Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain. Spine 26:226–229

    Article  CAS  PubMed  Google Scholar 

  9. Hashimoto M, Watanabe O, Hirano H (1996) Extraforaminal stenosis in the lumbosacral spine: efficacy of MR imaging in the coronal plane. Acta Radiol 37:610–613

    CAS  PubMed  Google Scholar 

  10. Jonsson B, Stromqvist B, Egund N (1989) Anomalous lumbosacral articulations and low back pain: evaluation and treatment. Spine 14:831–834

    Article  CAS  PubMed  Google Scholar 

  11. Luoma K, Vehmas T, Raininko R et al (2004) Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine 29(2):200–205

    Article  PubMed  Google Scholar 

  12. Nardo L, Alizai H, Virayavanich W et al (2012) Lumbosacral transitional vertebrae: association with low back pain. Radiology 265(2):497–503

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nicholson AA, Roberts GM, Williams LA (1988) The measured height of the lumbosacral disc in patients with and without transitional vertebrae. Br J Radiol 61:454–455

    Article  CAS  PubMed  Google Scholar 

  14. Otani K, Konno S, Kikuchi S (2001) Lumbosacral transitional vertebrae and nerveroot symptoms. J Bone Joint Surg Br 83-B: 1137–40

  15. Quinlan JF, Duke D, Eustace S (2006) Bertolotti’s syndrome: a cause of back pain in young people. J Bone Joint Surg Br 88:1183–1186

    Article  CAS  PubMed  Google Scholar 

  16. Taskaynatan MA, Izci Y, Ozgul A et al (2005) Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain. Spine 30:E210–E213

    Article  PubMed  Google Scholar 

  17. Vergauwen S, Parizel PM, van Breusegem L et al (1997) Distribution and incidence of degenerative spine changes in patients with a lumbo-sacral transitional vertebra. Eur Spine J 6:168–172

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Berven SH, Deviren V, Smith JA et al (2003) Management of fixed sagittal plane deformity: outcome of combined anterior and posterior surgery. Spine 28:1710–1715

    PubMed  Google Scholar 

  19. Booth KC, Bridwell KH, Lenke LG et al (1999) Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine 24:1712–1720

    Article  CAS  PubMed  Google Scholar 

  20. Lafage V, Schwab F, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34(17):E599–E606

    Article  PubMed  Google Scholar 

  21. Schwab F, Ungar B, Blondel B et al (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine 37(12):1077–1082

    Article  PubMed  Google Scholar 

  22. Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19:1611–1618

    CAS  PubMed  Google Scholar 

  23. Yoshida G, Yasuda T, Togawa D et al (2014) Craniopelvic alignment in elderly asymptomatic individuals: analysis of 671 cranial centers of gravity. Spine 39(14):1121–1127

    Article  PubMed  Google Scholar 

  24. Mahato NK (2010) Morphological traits in sacra associated with complete and partial lumbarization of first sacral segment. Spine J 10:910–915

    Article  PubMed  Google Scholar 

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Correspondence to Kunio Yokoyama.

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Yokoyama, K., Kawanishi, M., Yamada, M. et al. Spinopelvic alignment and sagittal balance of asymptomatic adults with 6 lumbar vertebrae. Eur Spine J 25, 3583–3588 (2016). https://doi.org/10.1007/s00586-015-4284-4

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  • DOI: https://doi.org/10.1007/s00586-015-4284-4

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