Lee Choon Sung, Ha Jung-Ki, Kim Dae Geun, Hwang Chang Ju, Lee Dong-Ho, Cho Jae Hwan
From the Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Spine (Phila Pa 1976). 2015 Sep 1;40(17):E964-70. doi: 10.1097/BRS.0000000000000945.
Retrospective review of radiographs.
The objective of this study was to (1) determine the prevalence of lumbosacral transitional vertebra (LSTV) with computed tomography (CT) and (2) correlate LSTV presence with lumbar disc degeneration at each level by magnetic resonance imaging.
LSTV is a frequently observed abnormality. Although its prevalence in patients with adolescent idiopathic scoliosis (AIS) has been shown, no studies have yet examined the clinical importance of LSTV in patients with AIS.
This study included 385 consecutive patients who underwent surgery for AIS at a single center. Plain radiographs and CT scans were used to detect LSTV. Disc degeneration was analyzed at the L3-4, L4-5, and L5-S1 disc levels with magnetic resonance imaging. The difference in disc degeneration at each level by the presence of LSTV was also analyzed. The effect of lumbar curve type on the disc degeneration of each level was then determined. To minimize confounding factors, logistic regression analysis was performed.
The overall prevalence of LSTV in patients with AIS confirmed by CT scans was 12.2% (47/385). The proportion of grade II or more disc degeneration at the L4-5 level was higher in the LSTV(+) group than in the LSTV(-) group (29.8% vs.19.2%) although it was not statistically significant (P = 0.093). Large lumbar curves showed a positive correlation with disc degeneration at the L5-S1 level (P = 0.022).
The prevalence of LSTV in patients with AIS was 12.2%. A trend of early degeneration in L4-5 level discs was found in patients with AIS with LSTV although it was not statistically confirmed. Disc degeneration at the L5-S1 level is related to a large lumbar curve. If patients with AIS with large lumbar curves have LSTV, consideration should be given to stopping the distal fusion at L3 instead of L4.
X线片回顾性研究。
本研究的目的是（1）通过计算机断层扫描（CT）确定腰骶部移行椎（LSTV）的患病率，以及（2）通过磁共振成像将LSTV的存在与每个节段的腰椎间盘退变相关联。
LSTV是一种常见的异常情况。虽然其在青少年特发性脊柱侧凸（AIS）患者中的患病率已被证实，但尚无研究探讨LSTV在AIS患者中的临床重要性。
本研究纳入了在单一中心接受AIS手术的385例连续患者。使用平片和CT扫描检测LSTV。通过磁共振成像分析L3-4、L4-5和L5-S1椎间盘水平的椎间盘退变情况。还分析了LSTV的存在对每个节段椎间盘退变的影响。然后确定腰椎曲线类型对每个节段椎间盘退变的影响。为尽量减少混杂因素，进行了逻辑回归分析。
经CT扫描确诊的AIS患者中LSTV的总体患病率为12.2%（47/385）。LSTV（+）组L4-5节段II级或更高级别的椎间盘退变比例高于LSTV（-）组（29.8%对19.2%），尽管差异无统计学意义（P = 0.093）。大的腰椎曲线与L5-S1节段的椎间盘退变呈正相关（P = 0.022）。
AIS患者中LSTV的患病率为12.2%。在伴有LSTV的AIS患者中发现L4-5节段椎间盘有早期退变趋势，尽管未得到统计学证实。L5-S1节段的椎间盘退变与大的腰椎曲线有关。如果伴有大的腰椎曲线的AIS患者有LSTV，应考虑将远端融合止于L3而非L4。
4级。
