Abstract
BackgroundThe anteroposterior view of the lumbar plain radiograph (AP-LPR) was chosen as the original and first radiographic tool to determine and classify lumbosacral transitional vertebra with morphological abnormality (MA-LSTV) according to the Castellvi classification. However, recent studies found that AP-LPR might not be sufficient to detect or classify MA-LSTV correctly. The present study aims to verify the reliability of AP-LPR on detecting and classifying MA-LSTV types, taking coronal reconstructed CT images (CT-CRIs) as the gold criteria.MethodsPatients with suspected MA-LSTVs determined by AP-LPR were initially enrolled. Among them, those who received CT-CRIs were formally enrolled to verify the sensitivity of AP-LPR on detecting and classifying MA-LSTV types according to the Castellvi classification principle.ResultsA total of 298 cases were initially enrolled as suspected MA-LSTV, among which 91 cases who received CT-CRIs were enrolled into the final study group. All suspected MA-LSTVs were verified to be real MA-LSTVs by CT-CRIs. However, 35.2% of the suspected MA-LSTV types judged by AP-LPR were not consistent with the final types judged by CT-CRIs. Two suspected type IIIa and 20 suspected type IIIb MA-LSTVs were verified to be true, while 9 of 39 suspected type IIa, 9 and 3 of 17 suspected type IIb, and 11 of 13 suspected type IV MA-LSTVs were verified to truly be type IIIa, IIIb, IV and IIIb MA-LSTVs by CT-CRIs, respectively. Incomplete joint-like structure (JLS) or bony union structure (BUS) and remnants of sclerotic band (RSB) between the transverse process (TP) and sacrum were considered to be the main reasons for misclassification.ConclusionAlthough AP-LPR could correctly detect MA-LSTV, it could not give accurate type classification. CT-CRIs could provide detailed information between the TP and sacrum area and could be taken as the gold standard to detect and classify MA-LSTV.
Highlights
The anteroposterior view of the lumbar plain radiograph (AP-Lumbar plain radiograph (LPR)) was chosen as the original and first radiographic tool to determine and classify lumbosacral transitional vertebra with morphological abnormality (MALSTV) according to the Castellvi classification
All anteroposterior view of the lumbar plain radiograph (AP-LPR) were assessed regarding the presence of MA-Lumbosacral transitional vertebra (LSTV)
A total of 2026 patients who received AP-LPR were collected from the database
Summary
The anteroposterior view of the lumbar plain radiograph (AP-LPR) was chosen as the original and first radiographic tool to determine and classify lumbosacral transitional vertebra with morphological abnormality (MALSTV) according to the Castellvi classification. Recent studies found that AP-LPR might not be sufficient to detect or classify MA-LSTV correctly. The present study aims to verify the reliability of AP-LPR on detecting and classifying MA-LSTV types, taking coronal reconstructed CT images (CT-CRIs) as the gold criteria. Lumbosacral transitional vertebra (LSTV) is regarded as a congenital anomaly that has morphologic characteristics mixed between those of sacral and lumbar vertebrae, including lumbarization of the highest sacral segment (S1) and sacralization of the most inferior lumbar segment (L5) [1, 2]. Lumbar plain radiograph (LPR) could detect MALSTV while misinterpret NV-LSTV as a normal spinal sequence, as the latter has insidious characteristics. Four types of MA-LSTV have been classified: type I exhibits an enlarged TP measuring at least 19 mm in the craniocaudal dimension (a, unilateral; b, bilateral); type II exhibits a joint-like structure (JLS) (a, unilateral; b, bilateral) with sclerotic band(s); type III exhibits a bony union structure (BUS) (a, unilateral; b, bilateral); and type IV includes a unilateral type II transition along with a type III on the contralateral side
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