Farshad-Amacker Nadja A, Herzog Richard J, Hughes Alexander P, Aichmair Alexander, Farshad Mazda
MRI Radiology Department, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA.
Spinal Imaging, Radiology Department, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
Spine J. 2015 Jun 1;15(6):1210-6. doi: 10.1016/j.spinee.2013.10.029. Epub 2013 Nov 8.
The relation between specific types of lumbosacral transitional vertebra and the degree of degeneration at and adjacent to the transitional level is unclear. It is also unknown whether the adjacent cephalad segment to a transitional vertebra is prone to greater degeneration than a normal L5-S1 level.
The purpose of this study was to evaluate the relation between specific lumbosacral transitional vertebra subtypes according to the Castellvi classification, and to determine the severity of degeneration at the transitional level and the adjacent cephalad segment.
This study was a retrospective review.
Ninety-two subjects with lumbosacral transitional vertebra grade 2 or higher and 94 control subjects without were retrieved from a picture archiving and communication system (PACS) search.
Disc degeneration parameters at the transitional and at the adjacent cephalad level were measured.
After institutional review board approval, 92 subjects (42 men; mean age, 57±16 years) with lumbosacral transitional vertebra grade 2 or higher and 94 control subjects (41 men; mean age, 51±16 years) without were retrieved from a PACS search. Degeneration of the last two segments of the lumbar spine was quantified using the Pfirrmann and Modic classifications, along with documentation of annular tears, disc herniations, and disc height, and were compared between the two groups. Furthermore, L5-S1 levels in the control subjects were compared with the adjacent cephalad segments of the transitional vertebrae for the same parameters.
Although the control subjects, at L5-S1, had moderate to severe degeneration by Pfirrmann grades (31%) and Modic changes ([MC] 20%), in comparison, the discs at the transitional level of the lumbosacral transitional vertebra group demonstrated significant less degeneration (3% and 1%, respectively; each p<.05). The adjacent cephalad segments of the lumbosacral transitional vertebra group showed significantly greater degeneration (Pfirrmann grade 5, 39%; MC, 30%) compared with the L4-L5 level in control subjects (16% and 11%, respectively; each p<.05). The severity of disc degeneration using all parameters correlated with the type of lumbosacral transitional vertebra. The degree of degeneration of L5-S1 in control subjects was similar to the adjacent cephalad segment in lumbosacral transitional vertebrae.
Increasing the mechanical connection of a lumbosacral transitional vertebra protects the disc at the transitional level and predisposes the adjacent cephalad segment to greater degeneration. The adjacent cephalad segment had a comparable degree of degeneration as the L5-S1 level in control subjects.
特定类型的腰骶部移行椎与移行节段及其相邻部位的退变程度之间的关系尚不清楚。同样未知的是，移行椎相邻的上位节段是否比正常的L5-S1节段更容易发生退变。
本研究的目的是评估根据Castellvi分类的特定腰骶部移行椎亚型之间的关系，并确定移行节段及其相邻上位节段的退变严重程度。
本研究为回顾性研究。
通过图片存档与通信系统（PACS）检索，纳入92例腰骶部移行椎2级或更高等级的受试者以及94例无腰骶部移行椎的对照受试者。
测量移行节段及其相邻上位节段的椎间盘退变参数。
经机构审查委员会批准后，通过PACS检索纳入92例腰骶部移行椎2级或更高等级的受试者（42例男性；平均年龄57±16岁）以及94例无腰骶部移行椎的对照受试者（41例男性；平均年龄51±16岁）。使用Pfirrmann和Modic分类对腰椎最后两节段的退变情况进行量化，并记录环状撕裂、椎间盘突出和椎间盘高度，然后在两组之间进行比较。此外，对对照受试者的L5-S1节段与移行椎相邻的上位节段的相同参数进行比较。
虽然对照受试者的L5-S1节段按Pfirrmann分级有中度至重度退变（31%）以及Modic改变（20%），但相比之下，腰骶部移行椎组移行节段的椎间盘退变明显较少（分别为3%和1%；均P<0.05）。腰骶部移行椎组相邻的上位节段与对照受试者的L4-L5节段相比，退变明显更严重（Pfirrmann 5级，39%；Modic改变，30%）（分别为16%和11%；均P<0.05）。使用所有参数评估的椎间盘退变严重程度与腰骶部移行椎的类型相关。对照受试者中L5-S1节段的退变程度与腰骶部移行椎相邻的上位节段相似。
增加腰骶部移行椎的机械连接可保护移行节段的椎间盘，并使相邻的上位节段更容易发生更严重的退变。相邻的上位节段与对照受试者中L5-S1节段的退变程度相当。
