Anatomical changes in lumbosacral vertebrae and their correlation with facet joint-derived low back pain in patients with hip osteoarthritis after total hip arthroplasty: a cohort study.

Background: Little is known about the anatomical changes in lumbosacral vertebrae and their correlation with facet joint-derived low back pain in patients with hip osteoarthritis (HOA) after total hip arthroplasty. Methods: Seventy-four HOA patients with low back pain who underwent initial total hip arthroplasty were included. Their Harris Hip Score (HHS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) and anatomical parameters were analyzed. Paired t-tests were used to compare the various index scores before and after surgery, and independent sample t-tests were used for the between-group comparisons. Results: The HHS and ODI significantly changed at 3 and 6 months postoperatively [HHS: preoperative (43.56±4.34) vs. 3 months (80.34±5.23) vs. 6 months (84.37±4.78); ODI: preoperative (36.26±5.34) vs. 3 months (26.44±3.23) vs. 6 months (19.34±3.27); P<0.001]. At the first 3 months after surgery, the VAS low back pain score decreased from 5.24±1.21 to 2.89±1.03 (P<0.001), and the VAS hip pain score decreased from 7.45±1.32 to 2.34±1.12 (P<0.001). There was also a statistically significant difference between the preoperative and 1-month postoperative anatomical indices: lumbar lordosis (LL) increased significantly after surgery [preoperative (43.46°±13.89°) vs. 1 month (48.27°±14.42°), P=0.001], while slip angle (SA) decreased significantly [preoperative (89.20°±5.03°) vs. 1 month (84.45°±4.89°), P=0.010]. Sacral slope (SS) and radial abduction angle (RAA) showed significant postoperative changes compared with preoperative assessments; after surgery, SS increased significantly [preoperative (31.33°±8.23°) vs. 1 month (37.65°±8.19°), P=0.006), while RAA decreased significantly [preoperative (42.32°±8.12°) vs. 1 month (35.45°±7.67°), P=0.021]. Moreover, the increase of LL was both significantly correlated with the decrease of the VAS low back pain (P=0.009) and the VAS hip pain score (P=0.038). Conclusions: Total hip arthroplasty was associated with the anatomical changes in lumbosacral vertebrae.

Sacral Dysmorphism and Lumbosacral Transitional Vertebrae (LSTV) Review.

BACKGROUND: Anatomic variation in the relationship between the lumbar spine and sacrum was first described in the literature nearly a century ago and continues to play an important role in spine deformity, low back pain (LBP), and pelvic trauma. This review will focus on the clinical and surgical implications of abnormal lumbosacral anatomy in the context of sacroiliac joint (SIJ) disease, spine deformity, and pelvic trauma. METHODS: A PubMed search using the keywords "lumbosacral transitional vertebrae," "LSTV," "transitional lumbosacral vertebrae," "TLSV," and "sacral dysmorphism" was performed. The articles presented here were evaluated by the authors. CLINICAL SIGNIFICANCE: The prevalence of LSTV varies widely in the literature from 3.9-% to 35.6% in the spine literature, and sacral dysmorphism is described in upwards of 50% of the population in the trauma literature. The relationship between LSTV and LBP is well established. While there is no agreed-on etiology, the source of pain is multifactorial and may be related to abnormal biomechanics and alignment, disc degeneration, and arthritic changes. SURGICAL IMPLICATIONS: Understanding abnormal lumbosacral anatomy is crucial for preoperative planning of SIJ fusion, spine deformity, and pelvic trauma surgery. LSTV can alter spinopelvic parameters crucial in planning spine deformity correction. Traditional safe zones for sacroiliac screw placement do not apply in the first sacral segment in sacral dysmorphism and risk iatrogenic nerve injury. CONCLUSIONS: LSTV and sacral dysmorphism are common anatomic variants found in the general population. Abnormal lumbosacral anatomy plays a significant role in clinical evaluation of LBP and surgical planning in SIJ fusion, spine deformity, and pelvic trauma. Further studies evaluating the influence of abnormal lumbosacral anatomy on LBP and surgical technique would help guide treatment for these patients.

Transitional Female Sacrum: Dimensions, Alterations in Dorsal Pelvic Structure, and Potential Obstetric Implications.

OBJECTIVES: The space available within the female pelvis is determined by the morphology of all bony components constituting the pelvic skeleton. Although several studies have investigated the impact of hip-bone structural variations in on parturition, the potential effects of commonly occurring lumbosacral transitional vertebrae (LSTV) variations have been underreported. This descriptive morphometric study reports dimensions of the female sacrum associated LSTV variations and suggests their probable mechanistic effects on normal labor. METHODS: One hundred and twelve female osteological sacral specimens with LSTV were examined for the type of transitional anomaly. Position, height, and surface areas of the auricular surfaces, interauricular distances, sacral heights, S1 body width and upper surface areas, and articulating areas of S1 facets were measured and compared with data from non-transitional samples. RESULTS: Female LSTV predominantly presented as accessory L5-S1 articulations (unilateral and bilateral) and degrees of lumbarization (separation of the first sacral segment). Since some of these alterations were found to be significantly associated with changes in sacral size, these features, in conjunction with cranial shift of the auricular surfaces, may be associated with overall in dorsal pelvic dimensions. CONCLUSIONS: Structural alterations identified in female LSTV sacrum may change dorsal pelvic dimensions and thus, the availability of dorsal pelvic space, potentially altering the biomechanics of normal labor.

Relationship between transitional lumbosacral vertebrae and eight lumbar vertebrae in a breeding colony of Labrador Retrievers and Labrador Crosses.

OBJECTIVE: Transitional lumbosacral vertebrae (TLSV) is a hereditary malformation of the spinal column diagnosed in various dog breeds. The aim of this study was to explore whether different lumbosacral phenotypes have an inherited basis. METHODS: Radiographs of all dogs within a breeding colony were performed and assessed. A comparison of the incidence of TLSV, eight lumbar vertebrae (8LV), and fusion of the first caudal vertebrae to the sacrum or near fusion of this area was made between litters of normal parentage and litters where one or both of the parents had an anomaly. RESULTS: Of the 119 puppies included in the study, 69 had normal conformation, 9 had 8LV, 9 had TLSV and 32 had fusion of the first caudal vertebra (Ca1) to the caudal sacral segment or a reduced joint space in this area. Results indicated that all the abnormal types likely had common underlying genetic causes. Compared with the population as a whole, significantly more progeny were observed to have abnormalities of the sacral region when both parents were affected by either fusion of Ca1 to the third sacral vertebra (S3) and/or had 8LV. Significantly more progeny were normal compared with the entire study population when both parents were normal. Strong similarity between parental and progeny phenotypes suggested that the characteristics were heritable and likely influenced by major gene effects. CONCLUSION: When performing screening radiographs for TLSV, assessment for 8LV and fusion of Ca1 to S3 should be included.

Intervertebral foramen puncture combined with internal fixation via paraspinal approach for treatment of lum-bosacral tuberculosis / 局解手术学杂志

Objective To explore the operative indications and efficacy of intervertebral foramen puncture combined with internal fixa -tion via paraspinal approach in the treatment of lumbosacral tuberculosis .Methods A total of 69 patients who treated with intervertebral fo-ramen puncture combined with internal fixation via paraspinal approach in spinal surgery department of Daping hospital affiliated to army medical university from January 2010 to January 2017 were retrospectively analyzed .All patients had preoperative standardized oral isoniazid , rifampicin,pyrazinamide,ethambutol for 2 to 4 weeks.The surgical methods included intervertebral foramen puncture ,drainage of paraverte-bral abscess and posterior paraspinal muscle gap approach fixation .The surgery time,intraoperative blood loss ,postoperation drainage ,abscess absorption,healing of lesions and Oswestry scores were recorded and observed .Results The operation time was from 130 to 220 minutes, with average of 140 minutes;the blood loss was from 50 to 150 mL,with average of 110 mL;the total volume of drainage was 30 to 180 mL, with average of 70 mL.All patients were followed up for 12 to 21 months.All cases were recovered except 1 patient who suffered from sacral tuberculosis received debridement and suturing caused by cutaneous necrosis .There was no infection , injury of spinal cord and nerve nor looseness or shift of internal fixation .The abscess was completely absorbed after 12 months.The Oswestry scores before surgery was (68.15 ± 18.36),while it was(11.64 ±8.12) at final followed-up,the difference was significant(P<0.05).Conclusion The surgical treatment of intervertebral foramen puncture combined with internal fixation via paraspinal approach is effective for patients who suffered large paraverte -bral abscess, parts of vertebral body collapse with segmental instability and mild kyphosis of spine with spinal cord disfunction ,which is a safe and effective surgical method .

Characteristics change and clinical significance of intervertebral disc and spinal canal in adolescent / 局解手术学杂志

Objective To study the developmental patterns and aging characteristics of anterior intervertebral disc and spinal canal based on anatomy CT scan and three dimensional reconstruction imaging measurement in the adolescents ages from 12 ~18 years old,and to provide the anatomical basis for the treatment and prevention of disc herniation diseases.Methods A total of 30 adolescents,who were with normal spines and without any the problems of nervous system,were selected to do CT scan of lumbosacral vertebrae through dual-source 64-slice spiral CT.CT original data of lumbosacral,which were translated into DICOMformat,were measured and analyzed statistically with Mim-ics software.Results There was no significant difference among the intervertebral disc and the superior sagittal diameter of the spinal canal, which were not influenced by gender (P >0.05).The intervertebral disc and the superior sagittal diameter of the spinal canal would increase with age with wavy trends,and there were some significant differences(P <0.05).Conclusion The anatomy parameters of lumbosacral disc and spinal changed regularly.In order to achieve satisfactory results of the lumbosacral disease treatment,it must be combined with individual radiographic findings,biomechanics and materials science,etc.

Are spinal or paraspinal anatomic markers helpful for vertebral numbering and diagnosing lumbosacral transitional vertebrae?

OBJECTIVE: To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. MATERIALS AND METHODS: Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. RESULTS: The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. CONCLUSION: The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.

Are Spinal or Paraspinal Anatomic Markers Helpful for Vertebral Numbering and Diagnosing Lumbosacral Transitional Vertebrae?

OBJECTIVE: To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. MATERIALS AND METHODS: Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. RESULTS: The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. CONCLUSION: The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.

Diffusion weighted imaging of lumbar sacral nerve roots in normal and degenerative lumbosacral vertebrae / 实用医学杂志

Objective To explore the characteristics of diffusion weighted imaging (DWI) of lumbar sacral nerve roots (LSNR)in normal and degenerative lumbosacral vertebrae. Methods The research recruited 20 normal volunteers and 31 patients with spinal stenosis on conventional MRI and DWI scans in lumbosacral spine. We measured the areas from lumbar 3 to sacral 1 at the intervertebral spaces and reconstructed the 3D maximum intensity projection (MIP) and counted the apparent diffusion coefficient (ADC)of LSNR and ganglions. Results In the control group, 196 (98%) LSNR ran symmetrically and lateroinferiorly and 200 ganglions were well defined on MIP of DWI. In the patients group, 74 LSNR showed changes of compression on both T1WI and T2WI, in which DWI appeared thin and distorted in 59 (80%). The ADC value of LSNR were(1.70 ± 0.40)× 10-3 mm2/s and(1.98 ± 0.57) × 10-3 mm2/s separately in normal volunteers and patients (P=0.000), while the ADC values of ganglions were(1.42 ± 0.21)× 10-3 mm2/s and (1.54 ± 0.53)× 10-3 mm2/s respectively in normal volunteers and patients (P=0.000). Conclusion DWI can display the pattern and course of LSNR and ganglions, which indicate that ADC values of compressed LSNR and ganglions are higher than normal ones.

Significance of age related changes in lumbosacral pedicle of adolescent / 局解手术学杂志

Objective To study the pedicle of lumbosacral developmental patterns and aging characteristics by means of studying the ado-lescents aging from 12~18 years old,and provide the basis for image and three-dimensional analysis of the treatment of spinal diseases. Meth-ods Select the 30 normal spines of adolescents without any the problems of nervous system,who did thin spiral CT scan of lumbosacral verte-brae. The original data in the form of DICOM were put into three-dimensional software to do the relevant measurement and analyzed according to gender and age. Results There were no significant differences between the pedicle of lumbosacral E/F angle and DSP /DNP and these differ-ences were not influenced by age and gender(P>0. 05). The physical development of human increases gradually with age and has some signifi-cant differences. Conclusion A regular change process and operation in the region value in patients with lumbarsacrum is displayed. But it must be combined with the results of individual imagine and the technology of reverse engineering and the support of rapid prototype manufactur-ing. Only in this way can it meet the satisfaction of individualized treatment.

Design and biomechanical test of a novel lumbosacral anterior plate / 第三军医大学学报

Objective To design a new lumbosacral anterior plate by statistical analysis for the numerical value of the anatomic structure in Chinese.Methods The numerical value of lumbosacral angle and height of lumbosacral vertebrae,and discus intervertebralis were measured in 350 orthotropia and lateral view X-ray pictures of lumbosacral vertebrae of adult normal individuals.According to the acquired amplitude of lumbosacral vertebrae in Chinese,we designed the modified lumbosacral anterior plate,and then tested the plate in 4 different states of working condition on 8 fresh spinal columns to assay biomechanical data,and the results were compared with those of lumbosacral anterior secure plate(PACH).Results The amplitude of lumbosacral angle were 125 to 135,the heights of anterior border L5 and S1 vertebrae were(27.06?2.30) and(22.3?2.8)mm,the height of L5S1 discus intervertebralis was(8.2?0.3)mm.The flex bias and the compression rigidity had significant deviation for the vertebral column fixed the modified plate [flexation(4.706?0.012)mm,extension(4.549?0.298)mm,lateral bending(5.412?0.384)mm,average value of rigidity in 400 N(105.8?7.6)N/mm] and PACH[flexation(5.241?0.113) mm,extension(5.662?0.246)mm,lateral bending(6.767?0.017)mm,and average value of rigidity(87.4?4.2)N/mm] respectively,with statistical significance among them(P