Center for Musculoskeletal Surgery, Charité -University Medicine, Berlin, Germany.
Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité -University Medicine, Berlin, Germany.
PLoS One. 2022 Sep 29;17(9):e0274581. doi: 10.1371/journal.pone.0274581. eCollection 2022.
Lumbo-sacral transitional vertebrae (LSTV) are one of the most common congenital variances of the spine. They are associated with an increased frequency of degeneration in the cranial adjacent segment. Hypermobility and concomitant increased loads are discussed as a possible reason for segmental degeneration. We therefore examined the lumbar and segmental motion distribution in patients with LSTV with flexion-extension radiographs.
A retrospective study of 51 patients with osteochondrosis L5/S1 with flexion and extension radiographs was performed. Of these, 17 patients had LSTV and were matched 1:1 for age and sex with patients without LSTV out of the collective of the remaining 34 patients. The lumbar and segmental range of motion (RoM) by segmental lordosis angle and the segmental wedge angle were determined. Normal distribution of parameters was observed by Kolmogorov-Smirnov-test. Parametric data were compared by paired T-test. Non-parametric data were compared by Wilcoxon-rank-sum-test. Correlations were observed using Spearman's Rank correlation coefficient. A p-value <0.05 was stated as statistically significant.
Patients with LSTV had mean age of 52.2±10.9, control group of 48.9±10.3. Both groups included 7 females and 10 males. Patients with LSTV presented with reduced RoM of the lumbar spine (LSTV 37.3°±19.2°, control 52.1°±20.5°, p = 0.065), however effects were statistically insignificant. LSTV significantly decreased segmental RoM in the transitional segment (LSTV 1.8°±2.7°, control 6.7°±6.0°, p = 0.003). Lumbar motion distribution differed significantly; while RoM was decreased in the transitional segment, (LSTV 5.7%, control 16.2%, p = 0.002), the distribution of lumbar motion to the cranial adjacent segment was increased (LSTV 30.7%, control 21.6%, p = 0.007).
Patients with LSTV show a reduced RoM in the transitional segment and a significantly increased motion distribution to the cranial adjacent segment in flexion-extension radiographs. The increased proportion of mobility in the cranial adjacent segment possibly explain the higher rates of degeneration within the segment.
腰骶部过渡性椎体（LSTV）是脊柱最常见的先天性变异之一。它们与颅侧相邻节段退变的发生率增加有关。过度活动和随之而来的负荷增加被认为是节段退变的一个可能原因。因此，我们通过屈伸位 X 线片检查了 LSTV 患者的腰椎和节段运动分布。
对 51 例患有 L5/S1 型骨软骨病的患者进行了屈伸位 X 线片回顾性研究。其中 17 例为 LSTV 患者，与其余 34 例患者中无 LSTV 的患者年龄和性别相匹配，各 17 例。通过节段前凸角和节段楔角确定腰椎和节段活动范围（RoM）。通过 Kolmogorov-Smirnov 检验观察参数的正态分布。通过配对 T 检验比较参数数据。通过 Wilcoxon 秩和检验比较非参数数据。使用 Spearman 秩相关系数观察相关性。p 值<0.05 表示具有统计学意义。
LSTV 患者的平均年龄为 52.2±10.9 岁，对照组为 48.9±10.3 岁。两组均包括 7 名女性和 10 名男性。LSTV 患者的腰椎活动范围（LSTV 37.3°±19.2°，对照组 52.1°±20.5°，p=0.065）减小，但统计学上无显著性差异。LSTV 显著降低了过渡节段的节段活动范围（LSTV 1.8°±2.7°，对照组 6.7°±6.0°，p=0.003）。腰椎运动分布明显不同；过渡节段的 RoM 减少（LSTV 5.7%，对照组 16.2%，p=0.002），而向颅侧相邻节段的运动分布增加（LSTV 30.7%，对照组 21.6%，p=0.007）。
LSTV 患者在屈伸位 X 线片中显示过渡节段的 RoM 减小，向颅侧相邻节段的运动分布显著增加。颅侧相邻节段活动度的比例增加可能解释了该节段退变率较高的原因。
