Anesth Pain Med.  2020 Jan;15(1):103-110. 10.17085/apm.2020.15.1.103.

The prevalence and clinical significance of transitional vertebrae: a radiologic investigation using whole spine spiral three-dimensional computed tomographic images

• Doo AR
• Lee J
• Yeo GE
• Lee KH
• Kim YS
• Mun JH
• Han YJ
• Son JS

• KMID: 2500463
• DOI: http://doi.org/10.17085/apm.2020.15.1.103

Abstract

Background
Errors in counting spinal segments are common during interventional procedures when there are transitional vertebrae. In this study, we investigated the prevalence of the transitional vertebrae including thoracolumbar transitional vertebra (TLTV) and lumbosacral transitional vertebrae (LSTV). The relationship between the existence of TLTV and abnormal rib count or the existence of LSTV were also evaluated.
Methods
The vertebral levels were counted craniocaudally, starting from C1, based on the assumption of 7 cervical, 12 thoracic, and 5 lumbar vertebrae, using whole spine spiral three-dimensional computed tomographic images. The 20th and 25th vertebrae were defined as L1 and S1, respectively.
Results
In total, 150 patients had TLTV, with a prevalence of 11.2% (150/1,340). LSTV was observed in 111 of 1,340 cases (8.3%). Sacralization was observed in 68 of 1,340 cases (5.1%) and lumbarization in 43 of 1,340 cases (3.2%). There was a significant relationship between the existence of TLTV and the abnormal rib count (odds ratio [OR]: 117.26, 95% confidence interval [95% CI]: 60.77–226.27; P < 0.001) and LSTV (OR: 7.38, 95% CI: 3.99–13.63; P < 0.001).
Conclusions
Our study results suggest that patients with TLTV are more likely to have an abnormal rib count or LSTV. If a TLTV or LSTV is seen on the fluoroscopic image, a whole spine image is necessary to permit accurate numbering of the lumbar vertebra.

Keyword

Anomaly; Computed tomography; Prevalence; Rib; Spine; Variation

Figure

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  Fig. 1 The CONSORT diagram.

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  Fig. 2 Volume rendering reconstruction images of the anterior aspect of the lumbar vertebrae in case of thirteenth ribs (lumbar ribs) and lumbarization of S1. (A) If the lowest ribs are interpreted as 12th ribs (white arrows), the lumbar spinal configuration might be identified as sacralization. (B) By counting inferiorly from C1, the lowest ribs are confirmed as thirteenth ribs and the lowest incomplete-fused vertebra as S1 (lumbarization).

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  Fig. 3 Whole spine spiral three-dimensional computerized tomographic (CT) images of patient with thirteenth ribs (lumbar ribs) without lumbosacral transitional vertebrae. (A) Volume rendering reconstruction image of the thoracolumbar spine and ribs with the sternum removed. Thirteenth ribs are clearly shown (white arrows). (B) Axial CT image of L1. Articulations between L1 and the thirteenth ribs are well demonstrated (black arrows). (C) Axial CT image of L2. L2 has transverse processes typically.

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  Fig. 4 Simple rib anterioposterior (AP) image and volume rendering reconstruction images of the anterior aspect of the lumbar vertebrae. This case has thoracolumbar transitional vertebra (TLTV) of 12th thoracic vertebra (type IV) and sacralization. (A) There are 11 normal ribs. (B) If the TLTV (12th vertebra) is interpreted as L1, the lumbar spinal configuration might be identified as lumbarization. (C) The facet joint (black arrow) is shown on the right side of 12th TLTV on the simple rib AP image. (D) An accessory ossification center with a facet joint (white arrow) on the right side on an axial computerized tomographic image.

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  Fig. 5 Volume rendering reconstruction images of the anterior aspect of the lumbar vertebrae. This images showing different type of thoracolumbar transitional vertebra (TLTV) with or without lumbosacral transitional vertebra (LSTV). (A) TLTV type I with LSTV type IIa. (B) TLTV type I without LSTV. (C) TLTV type IIb with LSTV type IIb. (D) TLTV type IIb. (E) TLTV type IV with LSTV type IIa. (F) TLTV type IV.

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