Anat Biol Anthropol.  2019 Mar;32(1):31-42. 10.11637/aba.2019.32.1.31.

Incidence Rate of Lumbosacral Transitional Vertebrae and Measurement of their Cross-sectional Areas of Vertebral Canal and Dural Sac Using Magnetic Resonance Imaging

Affiliations
  • 1Department of Anatomy, College of Medicine, Pusan National University, Korea. sikyoon@pusan.ac.kr
  • 2Daegu Wooridul Spine Hospital, Korea.

Abstract

Human lumbar spines usually consist of five vertebrae; however, some individuals have vertebral anomalies with four or six lumbar vertebrae because of the lumbarized first sacral vertebra (lumbarization) or the sacralized fifth lumbar vertebra (sacralization), respectively. These vertebral anomalies are called lumbosacral transitional vertebrae (LSTV). This study was performed to determine the prevalence of LSTV and to measure their cross-sectional areas of vertebral canal and dural sac in Koreans using magnetic resonance imaging. We evaluated 9709 patients, comprising of 5570 male and 4139 female subjects. The prevalence of LSTV in our study population was 3.77%, with a higher incidence of lumbarization than sacralization (p<0.05). The prevalence of lumbarization was 2.27%, with a higher rate in men (60.2%), while the incidence of sacralization was 1.50%, with a higher rate in women (62.7%). Differences between the groups were compared separately for the L4~L5 level which represents the level of lumbarization, and the L5~S1 level which represents the level of sacralization. When the vertebral canal cross-sectional areas (VCCSA) were compared between the normal and LSTV groups, the size of the vertebral canal was found to be smaller in the lumbarization group than in the normal group at the L4~L5 level (p<0.001), while there was no significant difference in VCCSA between the normal and LSTV groups at the L5~S1 level. However, when the dural sac cross-sectional areas were compared between the normal and LSTV groups, the size of the dural sac was larger in the LSTV group than in the normal group at the L5~S1 level (p<0.001). These results could be clinically used as one of the parameters for evaluating lumbar vertebral canal stenosis with LSTV in Koreans.

Keyword

Lumbosacral transitional vertebrae; Lumbarization; Sacralization; Vertebral canal; Magnetic resonance imaging

MeSH Terms

Constriction, Pathologic
Female
Humans
Incidence*
Lumbar Vertebrae
Magnetic Resonance Imaging*
Male
Prevalence
Spine*

Figure

  • Fig. 1. (A) Cervicothoracic localizer scan demonstrating the surface marker (arrow) to be at the T12 vertebral body. (B-D) Thoracolumbar localizer scan again demonstrates the marker (arrows), which is at the T12 vertebral level. Counting the vertebral levels in a cranial-to-caudal manner under the assumption that there are 12 thoracic type vertebrae reveals this patient has a fifth lumbar-type vertebrae (B, normal). This patient has sixth lumbar-type vertebrae (C, lumbarization). This patient has fourth lumbar-type vertebrae (D, sacralization).

  • Fig. 2. Schematic illustration of the measurement methods used in this study. (A) The cross-sectional areas of the vertebral canal and dural sac were measured on a transverse image of three lumbosacral regions where herniated intervertebral disc often occurs. In normal patients, the images were obtained from two levels above the intervertebral disc between L5 and S1; in patients with transitional vertebrae, the images were obtained from two levels above the disc under the deformed vertebral segment. The cross-sectional areas of the vertebral canal and dural sac were measured on transverse plane images nearest to the center of intervertebral disc in sagittal plane (red lines: transverse plane image reference lines). (B) The measurement of the vertebral canal cross-sectional area encompassing the inner area of the vertebral canal without ligamentum flavum, as shown by an inverted triangular dotted line on the image. The lateral border is the apex of facet joint, and the anterior border is the posterior longitudinal ligament or intervertebral disc. (C) The measurement of the dural sac cross-sectional area encompassing the area of the spinal dura mater, as shown by an oval dotted line on the image. LLB: left lateral border, RLB: right lateral border, SP: spinous pro-cess, ID: intervertebral disc, PLL: posterior longitudinal ligament, AFJ: apex of facet joint, L: lamina, LF: ligamentum flavum. A color version of this figure is available in the online journal.

  • Fig. 3. (A) To measure the cross-sectional areas of the vertebral canal and dural sac, transverse plane images were obtained at three lumbo-sacral intervertebral disc levels in the sagittal image (white lines: transverse plane image reference lines). (B) Axial MR image of the lumbar spine. The vertebral canal cross-sectional area was measured using the free-line region of interest calculator within the Infinitt PACS system in axial MR images, as shown by the red line in the image. (C) Axial MR image of the lumbar spine. The dural sac of the vertebral canal was measured using the free-line region of interest calculator within the Infinitt PACS system in axial MR images, as shown by an oval dotted line in the image. A color version of this figure is available in the online journal.

  • Fig. 4. Comparison of the mean cross-sectional areas of the ver-tebral canal and dural sac among the normal, lumbarization, and sacralization groups. ∗∗∗p<0.001 indicates statistical significance. Error bars indicate standard deviation. VC1: the vertebral canal cross-sectional area at the L4∼ L5 level of normal group, the L4∼ L5 level of lumbarization group, and the L4∼ S1 level of sacralization group. VC2: the vertebral canal cross-sectional area at the L5∼ S1 level of normal group, the L5∼ L6 level of lumbarization group, and the S1∼ S2 level of sacralization group. DS1: the dural sac cross-sectional area at the L4∼ L5 level of normal group, the L4∼ L5 level of lumbarization group, and the L4∼ S1 level of sacralization group. DS2: the dural sac cross-sectional area at the L5∼ S1 level of normal group, the L5∼ L6 level of lumbarization group, and the S1∼ S2 level of sacralization group. A color version of this figure is available in the online journal.

  • Fig. 5. Comparison of the vertebral canal cross-sectional areas according to age among the normal (A), lumbarization (B), and sacralization (C) groups. The cross-sectional areas according to age do not show significant difference between the normal and the lumbosacral transitional vertebrae group. The data were analyzed by one way ANOVA. A color version of this figure is available in the online journal.

  • Fig. 6. Comparison of the dural sac cross-sectional areas according to age among the normal (A), lumbarization (B), and sacralization (C) groups. The cross-sectional areas according to age do not show significant difference between the normal and the lumbosacral transitional ver-tebrae group. The data were analyzed by one way ANOVA. A color version of this figure is available in the online journal.


Reference

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