TY - JOUR
T1 - Sacral dysmorphism and lumbosacral transitional vertebrae (LSTV) review
AU - Matson, David M.
AU - Maccormick, Lauren M.
AU - Sembrano, Jonathan N.
AU - Polly, David W.
N1 - Publisher Copyright:
ÓInternational Society for the Advancement of Spine Surgery
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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.
AB - 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.
KW - Bertolotti syndrome
KW - LSTV
KW - Low back pain
KW - Lumbosacral transitional vertebrae
KW - Sacral dysmorphism
KW - Sacroiliac joint fusion
KW - Transitional lumbosacral vertebrae
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UR - http://www.scopus.com/inward/citedby.url?scp=85084003776&partnerID=8YFLogxK
U2 - 10.14444/6075
DO - 10.14444/6075
M3 - Review article
C2 - 32123653
AN - SCOPUS:85084003776
SN - 2211-4599
VL - 14
SP - S14-S19
JO - International Journal of Spine Surgery
JF - International Journal of Spine Surgery
ER -