Cheng Linxiang, Jiang Chao, Huang Jiawei, Jin Jiale, Guan Ming, Wang Yue
Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
J Clin Med. 2022 Apr 22;11(9):2339. doi: 10.3390/jcm11092339.
We aimed to comprehensively characterize degenerative findings associated with various types of lumbosacral transitional vertebra (LSTV) on magnetic resonance images. Three hundred and fifty patients with LSTV (52.3 ± 10.9 years), including 182 Castellvi type I, 107 type II, 43 type III, and 18 type IV, and 179 controls without LSTV (50.6 ± 13.1 years), were studied. Discs, endplates, and posterior vertebral structures were assessed and compared to those of controls for the most caudal three discs on MRIs. There were no differences in degenerative findings between patients with type I LSTV and controls. For types III and IV, the transitional discs had smaller sizes, lower Pfirrmann scores, and lower rates of disc bulging (2.3% and 5.6% vs. 39.1%), osteophytes (2.3% vs. 15.1%), disc herniation (2.3% and 5.6% vs. 31.8%), and Modic changes (2.3% and 5.6% vs. 16.8%) than controls. However, the cranial discs had more severe Pfirrmann scores, disc narrowing and spinal canal narrowing, and greater rates of disc herniation (41.9% and 50.0% vs. 25.7%), endplate defects (27.9% and 33.3% vs. 14.4%) and spondylolisthesis (18.6% vs. 7.3%) than controls. Type II LSTV was associated with degenerative findings in the cranial segments but to a lesser degree, as compared with type III/IV LSTV. Thus, Castellvi type III/IV LSTV predisposed the adjacent spinal components to degeneration and protected the transitional discs. Type II LSTV had significant effects in promoting transitional and adjacent disc degeneration. Type I LSTV was not related to spinal degeneration.
我们旨在全面描述磁共振成像上与各种类型腰骶移行椎（LSTV）相关的退变表现。研究了350例LSTV患者（52.3±10.9岁），包括182例Castellvi I型、107例II型、43例III型和18例IV型，以及179例无LSTV的对照者（50.6±13.1岁）。对椎间盘、终板和椎体后部结构进行评估，并与MRI上最尾端三个椎间盘的对照者进行比较。I型LSTV患者与对照者之间的退变表现无差异。对于III型和IV型，与对照者相比，移行椎间盘尺寸更小、Pfirrmann评分更低、椎间盘膨出率（2.3%和5.6%对39.1%）、骨赘形成率（2.3%对15.1%）、椎间盘突出率（2.3%和5.6%对31.8%）和Modic改变率（2.3%和5.6%对16.8%）更低。然而，与对照者相比，头侧椎间盘的Pfirrmann评分更高、椎间盘狭窄和椎管狭窄更严重，椎间盘突出率（41.9%和50.0%对25.7%）、终板缺损率（27.9%和33.3%对14.4%）和椎体滑脱率（18.6%对7.3%）更高。II型LSTV与头侧节段的退变表现相关，但与III/IV型LSTV相比程度较轻。因此，Castellvi III/IV型LSTV使相邻脊柱成分易于退变并保护移行椎间盘。II型LSTV在促进移行和相邻椎间盘退变方面有显著作用。I型LSTV与脊柱退变无关。
