Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Mizukami 123-1, Fujieda, Shizuoka, 426-8662, Japan.
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Eur Spine J. 2020 Sep;29(9):2215-2221. doi: 10.1007/s00586-020-06460-1. Epub 2020 May 18.
Lumbosacral transitional vertebrae (LSTV) often have nearthrosis between the L5 transverse processes and the sacral ala; this causes the formation of new bone and synovial-like tissue, which can entrap L5 nerve root. The present study aimed to examine the role of nearthrosis in L5 nerve root compression in patients with LSTV.
From 2008 to 2018, 65 patients were surgically treated for severe leg pain/numbness caused by L5 extraforaminal stenosis. The patients were assessed regarding the presence of LSTV, radiographic features of nearthrosis, operative/radiological findings, and clinical outcomes. CT/MRI were used to classify the patients into three groups: group A had L5 nerve root compression that was not related to nearthrosis, group B had L5 nerve root impingement due to nearthrosis with new bone formation, and group C had L5 nerve root impingement due to nearthrosis with synovial-like tissue. The relationships between the type of LSTV (based on the Castellvi's classification) and these three groups were investigated.
Although 26 of 65 patients had LSTV (40%), four were excluded because of less than 1-year follow-up. The 22 patients with LSTV were classified as type IA (n = 2), IIA (n = 13), and IIB (n = 7). In accordance with the radiological findings, there were eight patients in group A, six in group B, and eight in group C; the LSTV morphology did not significantly differ between groups.
L5 nerve root was compressed by nearthrosis in 64% of symptomatic patients with LSTV; this region should be carefully assessed in all symptomatic patients with LSTV.
腰骶移行椎（LSTV）的 L5 横突与骶骨翼之间常有关节融合；这会导致新骨和类似滑膜的组织形成，从而压迫 L5 神经根。本研究旨在探讨 LSTV 患者神经根受压与关节融合的关系。
2008 年至 2018 年，对 65 例因 L5 椎间孔外狭窄引起严重下肢疼痛/麻木的患者进行了手术治疗。评估患者是否存在 LSTV、关节融合的影像学特征、手术/影像学发现和临床结果。采用 CT/MRI 将患者分为三组：A 组为与关节融合无关的 L5 神经根受压，B 组为新骨形成导致的 L5 神经根受压，C 组为类似滑膜组织导致的 L5 神经根受压。研究了基于 Castellvi 分类的 LSTV 类型与这三组之间的关系。
虽然 65 例患者中有 26 例（40%）存在 LSTV，但有 4 例因随访时间不足 1 年而被排除在外。22 例 LSTV 患者分为 IA 型（n=2）、IIA 型（n=13）和 IIB 型（n=7）。根据影像学发现，A 组 8 例，B 组 6 例，C 组 8 例；各组间 LSTV 形态无显著差异。
64%有症状的 LSTV 患者的 L5 神经根受压与关节融合有关；对于所有有症状的 LSTV 患者，都应仔细评估该区域。
