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35 yo/female patient presents with non-specific LBP. This is a continuation of our prior case.

No prior trauma,  surgeries,  carcinoma or corticosteroid regimen.

What do you see?

AP VIEW LUMBAR APINE.

XRAY FINDINGS

At the lumbosacral junction, a LSTV (lumbar transitional VB) is present with a large spatulated TVP on the right with pseudoarthrosis and associated degenerative change.

 Seen below, the orginal Castellvi classification system derived in 1984.

Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Konin  AJNR 31  Nov-Dec 2010  www.ajnr.org

 

Konin, et al therorized in 2010 that  certain LSTV may be responsilbe for associated lower back discomfort, disc lesions, ipsilateral & contrateral facet pain & in the worst clinical scenario wrong level spinal surgery. (1)

DISCUSSION: LSTV types II and IV positively correlate with prevalence and severity of LBP and buttock pain according to Lorenzo Nardo, MD et al 2012. (2)
Lumbosacral vertebrae of Castellvi types II, III, and IV are associated with greater lumbar degeneration according to MD et al Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. (3)

REFERENCES:

  1. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance
    G.P. Konin and D.M. Walz   American Journal of Neuroradiology November 2010, 31 (10) 1778-1786; DOI: https://doi.org/10.3174/ajnr.A2036
  2. MUSCULOSKELETAL IMAGING: Lumbosacral Transitional Vertebrae and Low Back Pain Radiology: Volume 265: Number 2—November 2012 in radiology.rsna.org 
  3. Lumbosacral transitional vertebrae are associated with lumbar degeneration: retrospective evaluation of 3855 consecutive abdominal CT scans  Eur Radiol . 2020 Jun;30(6):3409-3416. doi: 10.1007/s00330-020-06691-2. Epub 2020 Feb 19.