LUMBOSACRAL TRANSITIONAL VERTEBRA: DOES IT ACCELERATE END PLATE DEGENERATION ?

Abstract

OBJECTIVE: Lumbosacral transitional vertebra (LSTV) which is one of the most common congenital abnormalities of lumbosacral junction is usually detected incidentally. LSTV may increase the motion above transitional segment and be associated with early degeneration. Degeneration of lumbar spine may be a result of normal aging, as well as a pathological process that affects nucleus pulposus and vertebral end plates, which is called intervertebral osteochondrosis. The aim of this study is to evaluate the association between intervertebral osteochondrosis and lumbosacral transitional vertebra.MATERIAL AND METHODS: We included 492 patients into the study and divided them into two groups depending on presence of LSTV. Patients without LSTV were counted as the control group. Patients in LSTV group was also classified into two groups as sacralized and lumbarized depending on the level of transitional vertebra. We noted the presence of spondylolisthesis, osteochondrosis, Modic signal changes, low back pain and nerve root symptoms in all groups. We compared osteochondrosis prevalences at one level above from transitional vertebrae to the same levels in patients without transitional vertebrae. We compared age distribution and frequency of sypmtoms in two groups.RESULTS: We detected Modic type 2 signal changes and intervertebral osteochondrosis more common in LSTV group (42.7% vs 28.7% and 67.1% vs. 38.3%, p<0.05). Intervertebral osteochondrosis prevelance at L4-5 in sacralized patients (52.7%), and at L5-S1 in lumbarized patients (63%) was found significantly higher than other levels and the same levels in control group (21.4% and 24.6%). Patients with low back pain were more common in the LSTV group and were seen at younger age (p <0.05).CONCLUSIONS: As a result of our study, we found that LSTV is associated with intervertebral osteochondrosis and Modic type 2 changes. Patients with transitional vertebrae tend to present with lower back pain at an earlier age due to abnormal load transfer in the vertebral column.