Tsoupras Andreas, Dayer Romain, Bothorel Hugo, Faundez Antonio
Paediatric Orthopaedics Unit, University Hospitals of Geneva, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Sci Rep. 2025 Mar 26;15(1):10357. doi: 10.1038/s41598-025-94609-7.
Lumbosacral transitional vertebrae (LSTV) are a common anomaly in 7-36% of the population. LSTV can contribute to mechanical low back pain and increase the risk of early degeneration in cranial segments due to hypermobility and stress. This study analyzed sagittal balance in young symptomatic LSTV patients and tried to identify compensatory mechanisms that may explain early degeneration. Nineteen symptomatic and skeletally mature subjects with LSTV were retrospectively identified. Imaging included standing biplanar spine radiographs and supine lumbar MRI. Sagittal balance parameters were measured, and LSTV were classified using the Castellvi classification. Vertical mid-vertebral angle differences were calculated using MRI and lateral radiographs. The cohort included 17 females and 2 males (mean age 16 ± 3 years). Mean pelvic incidence was 67°±8°. L1-S1 lordosis averaged 61°±10°, L4-S1 lordosis was 10° lower than expected, and L4-L5 lordosis was higher than literature values. Thirteen patients had L4-L5 discopathy, with nine showing additional abnormalities such as interspinous ligament edema or posterior facet hypertrophy. In our study, LSTV was associated with L5-S1 disc hypoplasia and altered lumbar lordosis, leading to compensatory L4-L5 hyperextension. These findings suggest early degeneration may result from abnormal lordosis distribution. Treatment should aim to optimize lordosis distribution to reduce stress on adjacent segments.
腰骶部移行椎（LSTV）是一种常见的异常情况，在7%至36%的人群中存在。LSTV可导致机械性下腰痛，并因活动过度和应力增加颅段早期退变的风险。本研究分析了有症状的年轻LSTV患者的矢状面平衡，并试图确定可能解释早期退变的代偿机制。回顾性确定了19例有症状且骨骼成熟的LSTV患者。影像学检查包括站立位脊柱双平面X线片和仰卧位腰椎MRI。测量矢状面平衡参数，并使用Castellvi分类法对LSTV进行分类。利用MRI和侧位X线片计算椎体垂直角差异。该队列包括17名女性和2名男性（平均年龄16±3岁）。平均骨盆入射角为67°±8°。L1-S1前凸平均为61°±10°，L4-S1前凸比预期低10°，L4-L5前凸高于文献值。13例患者存在L4-L5椎间盘病变，其中9例还表现出其他异常，如棘间韧带水肿或小关节后缘肥大。在我们的研究中，LSTV与L5-S1椎间盘发育不全和腰椎前凸改变有关，导致代偿性L4-L5过度伸展。这些发现表明早期退变可能是由异常的前凸分布引起的。治疗应旨在优化前凸分布，以减轻相邻节段的应力。
