Bayram Serkan, Altin Yekta Furkan, Kahraman Abdullah, Yağci Taha Furkan, Korkmaz Murat, Akgül Turgut
Department of Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye.
Acta Orthop Traumatol Turc. 2025 Apr 29;59(2):117-121. doi: 10.5152/j.aott.2025.24100.
Objective: This study aimed to examine the relationship between lumbosacral transitional vertebra (LSTV), classified by Castellvi's system, and lumbar disc degeneration, graded using Pfirrmann's classification, based on radiological assessment. Methods: This retrospective study analyzed 2516 patients (1548 females and 968 males) with a mean age of 51.83 ± 15.6 years with chronic low back pain who underwent lumbosacral magnetic resonance imaging and computed tomography scans at a single center between January 2018 and January 2021. Pfirrmann grading was used to assess L4-L5 intervertebral disc degeneration, and Castellvi classification determined the anatomical type of LSTV. Correlation analysis was performed to evaluate the association between LSTV presence and disc degeneration. Additionally, a proportional-odds ordinal logistic regression model was used to examine the relationship between Pfirrmann grade and patient-specific factors (age, gender, and LSTV presence). Results: According to Pfirrmann classification, 113 patients were grade I, 402 were grade II, 877 were grade III, 861 were grade IV, and 263 were grade V. A total of 771 patients (30.6%) did not have LSTV, while the remaining 1745 patients (69.4%) had LSTV. A statistically significant association was found between LSTV presence and Pfirrmann grade (P < .001, r=.200). Patients with LSTV had 0.75 times higher probability (95% CI: 0.58-0.90, P < .001) of exhibiting a higher Pfirrmann grade compared to those without LSTV. However, no significant correlation was observed between LSTV subtypes classified by Castellvi and Pfirrmann grade (P=.379). Additionally, age was significantly correlated with Pfirrmann classification, LSTV presence, and Castellvi classification (P < .001). Female patients had 1.34 times higher likelihood (95% CI: 1.19-1.49, P < .001) of exhibiting a higher Pfirrmann grade compared to male patients. Conclusions: This study highlights the significant association between LSTV and advanced disc degeneration, establishing LSTV as a potential risk factor for progressive spinal changes. It emphasizes the importance of early detection and targeted management, particularly for older adults and females who are more susceptible to severe degenerative changes. Level of Evidence: Level III, Prognostic Study.
本研究旨在基于影像学评估，探讨采用卡斯特尔维（Castellvi）系统分类的腰骶部移行椎（LSTV）与使用菲尔曼（Pfirrmann）分类法分级的腰椎间盘退变之间的关系。方法：这项回顾性研究分析了2516例慢性下腰痛患者（1548例女性和968例男性），其平均年龄为51.83±15.6岁，于2018年1月至2021年1月在单一中心接受了腰骶部磁共振成像和计算机断层扫描。采用菲尔曼分级法评估L4-L5椎间盘退变情况，卡斯特尔维分类法确定LSTV的解剖类型。进行相关性分析以评估LSTV的存在与椎间盘退变之间的关联。此外，使用比例优势有序逻辑回归模型来研究菲尔曼分级与患者特定因素（年龄、性别和LSTV的存在）之间的关系。结果：根据菲尔曼分类法，I级113例，II级402例，III级877例，IV级861例，V级263例。共有771例患者（30.6%）没有LSTV，其余1745例患者（69.4%）有LSTV。发现LSTV的存在与菲尔曼分级之间存在统计学显著关联（P <.001，r = 0.200）。与没有LSTV的患者相比，有LSTV 的患者出现更高菲尔曼分级的概率高0.75倍（95%置信区间：0.58 - 0.90，P <.001）。然而，卡斯特尔维分类的LSTV亚型与菲尔曼分级之间未观察到显著相关性（P = 0.379）。此外，年龄与菲尔曼分类、LSTV的存在和卡斯特尔维分类均显著相关（P <.001）。与男性患者相比，女性患者出现更高菲尔曼分级的可能性高1.34倍（95%置信区间：1.19 - 1.49，P <.001）。结论：本研究强调了LSTV与严重椎间盘退变之间的显著关联，将LSTV确立为进行性脊柱改变的潜在危险因素。它强调了早期检测和针对性管理的重要性，特别是对于更容易发生严重退行性改变的老年人和女性。证据水平：III级，预后研究。
