Mobile Vertebra Research Articles

Association of spinal anomalies with spondylolysis and spina bifida occulta.

To investigate the association of spinal anomalies with lumbar spondylolysis and spina bifida occulta (SBO). A total of 1190 patients with thoracic, abdominal, and pelvic computed tomography scans available were categorized according to the number of presacral (thoracic and lumbar) mobile vertebrae and the presence or absence of lumbosacral transitional vertebrae (LSTV). The prevalence of spondylolysis and SBO and the association of spinal anomalies with these disorders were evaluated. Normal morphology (17 mobile vertebra with no LSTV) was found in 607 men (86.5%) and 419 women (85.9%) and about 14% of patients had anomalies. Spondylolysis was found in 74 patients (6.2%), comprising 54 men (7.7%) and 20 women (4.1%). SBO involving the lumbar spine was found in 9 men (1.3%) and 2 women (0.4%). Spondylolysis was significantly more common in men with 18 vertebrae without LSTV (21.1%) than in those with 17 vertebrae without LSTV (7.2%) (p = 0.002). The prevalence of spinal anomalies was 55.6% in men and 50.0% in women with SBO that included a lumbar level was significantly higher than in both men (13.5%, p < 0.001) and women (4.8%, p = 0.003) without SBO. These findings indicate that there is a relationship between spinal anomalies and both spondylolysis and SBO, which may lead to elucidation of the mechanism of onset of spondylolysis and improve its treatment and prognosis. Awareness that patients with SBO involving the lumbar spine have an increased likelihood of a spinal anomaly may help to prevent level errors during spinal surgery.

Transitional vertebrae and numerical variants of the spine : prevalence and relationship to low back pain or degenerative spondylolisthesis.

Although lumbosacral transitional vertebrae (LSTV) are well-documented, few large-scale studies have investigated thoracolumbar transitional vertebrae (TLTV) and spinal numerical variants. This study sought to establish the prevalence of numerical variants and to evaluate their relationship with clinical problems. A total of 1,179 patients who had undergone thoracic, abdominal, and pelvic CT scanning were divided into groups according to the number of thoracic and lumbar vertebrae, and the presence or absence of TLTV or LSTV. The prevalence of spinal anomalies was noted. The relationship of spinal anomalies to clinical symptoms (low back pain, Japanese Orthopaedic Association score, Roland-Morris Disability Questionnaire) and degenerative spondylolisthesis (DS) was also investigated. Normal vertebral morphology (12 thoracic and five lumbar vertebrae without TLTV and LSTV) was present in 531 male (76.7%) and 369 female patients (75.8%). Thoracolumbar transitional vertebrae were present in 15.8% of males and 16.0% of females. LSTV were present in 7.1% of males and 9.0% of females. The prevalence of the anomaly of 16 presacral mobile vertebrae (total number of thoracolumbar vertebrae and TLTV) without LSTV was 1.0% in males and 4.1% in females, and that of the anomaly of 18 vertebrae without LSTV was 5.3% in males and 1.2% in females. The prevalence of DS was significantly higher in females with a total of 16 vertebrae than in those with normal morphology. There was no significant correlation between a spinal anomaly and clinical symptoms. Overall, 24% of subjects had anomalies in the thoracolumbar region: the type of anomaly differed between males and females, which could have significant implications for spinal surgery. A decreased number of vertebrae was associated with DS: numerical variants may potentially be a clinical problem. Cite this article: Bone Joint J2021;103-B(7):1301-1308.

Incidence of numerical variants and transitional lumbosacral vertebrae on whole-spine MRI.

ObjectivesThis study sets out to prospectively investigate the incidence of transitional vertebrae and numerical variants of the spine.Materials and methodsOver a period of 28 months, MRIs of the whole spine were prospectively evaluated for the presence of transitional lumbosacral vertebrae and numerical variants of the spine.ResultsMRI of the whole spine was evaluated in 420 patients, comprising 211 female and 209 male subjects. Two patients had more complex anomalies. Lumbosacral transitional vertebrae were seen in 12 patients: eight sacralised L5 (3 male, 5 female) and four lumbarised S1 (3 male, 1 female). The incidence of transitional vertebrae was approximately 3.3. % (14/418). Thirty-two (7.7 %) of 418 patients had numerical variants of mobile vertebrae of the spine without transitional vertebrae. The number of mobile vertebrae was increased by one in 18 patients (12 male, 6 female), and the number was decreased by one in 14 patients (4 male, 10 female).ConclusionsNumerical variants of the spine are common, and were found to be almost 2.5 times as frequent as transitional lumbosacral vertebrae in the study population. Only whole-spine imaging can identify numerical variants and the anatomical nature of transitional vertebrae. The tendency is toward an increased number of mobile vertebrae in men and a decreased number in women.Main messages• Numerical variants of the spine are more common than transitional vertebrae.• Spinal numerical variants can be reliably identified only with whole-spine imaging.• Increased numbers of vertebrae are more common in men than women.• Transitional lumbosacral vertebrae occurred in about 3.3 % of the study population.• The incidence of numerical variants of the spine was about 7.7 %.

The Value of Dynamic Radiographs in Diagnosing Painful Vertebrae in Osteoporotic Compression Fractures

Many authors have reported the increase in vertebral body height after vertebroplasty; if the fractured vertebrae are mobile, we should be able to demonstrate their mobility in radiographs. The purpose of this study was to discover the diagnostic value of dynamic radiographs and the percentage of mobile vertebrae in painful VCFs. From September 2005 to September 2008, 105 patients underwent surgery to treat 144 painful osteoporotic VCFs. The indications for surgery were severe pain and MR imaging-confirmed active edematous lesions. Preoperative sitting lateral radiographs of the fractured vertebrae were compared with supine cross-table (with a bolster beneath) lateral radiographs to determine the presence or absence of dynamic mobility. Kyphotic angle and anterior vertebral body height were measured. The patients' ages ranged from 62 to 90 years. There were 19 men and 86 women. The total number of mobile VCFs was 126 (87.5%). One hundred four (99%) patients had at least 1 mobile VCF. The average anterior vertebral height in sitting lateral radiographs was 13.53 ± 6.80 mm and increased to 22.01 ± 6.13 mm in supine cross-table with bolster lateral radiographs. The average vertebral body height increase was 8.48 ± 5.36 mm. Dynamic (sitting and supine with bolster) radiographs can be valuable in diagnosing painful vertebrae in VCFs. The sensitivity was 0.88 in this study.

Bone Cement Augmentation in the Prevention of Adjacent Segment Failure After Multilevel Adult Deformity Fusion

Prospective case report series and detailed description of technique. To describe a surgical procedure designed to prevent fracture and cutting-through and pullout of screws in the adjacent segment after multilevel deformity correction in adults. Surgery of adult deformities has a high complication rate. One of the potential late complications is the development of fracture at the first mobile segment above a multilevel lumbar or thoracolumbar spinal fusion that necessitates further surgical intervention with extension of the instrumentation. Augmentation with bone cement of the last instrumented vertebra and the first mobile vertebra has the potential to prevent this pathology. Three patients with degenerative thoracolumbar kyphoscoliosis and 3 with adjacent segment failure after correction surgery were treated. Cannulated and perforated pedicle screws were placed in the uppermost-instrumented vertebra. A vertebroplasty tube was inserted from 1 side at the center of the first mobile vertebra. Under C-arm control, vertebroplasty was performed in both vertebrae. Intraoperatively, there were no cement-related complications. Follow-ups at 6 and 12 (+/-2) months revealed there was no loss of correction, fracture or screw loosening in the augmented vertebrae. Bone cement augmentation of the uppermost screws and the first mobile vertebra in multilevel adult deformity and revision surgery seems to be a safe and potentially effective method of preventing adjacent segment failure.

Measuring movement at the low back.

The clinical importance of movements of the human spine is increasingly being realized but their measurement is difficult to carry out. Traditionally, measurement of spinal motion focuses on the lumbar spine as the mobile region and movement at the lower thoracic spine is largely ignored. The aim of this study was to test the hypothesis that sagittal movement at the low back is not confined to the lumbar spine. The range of sagittal movement and the amount of skin distraction during trunk flexion was studied in 10 normal subjects. Angular movement in the sagittal plane between the vertebra prominens and S2 ranged between 40 degree and 83 degree among the subjects. Concomitant skin distraction showed that a mean of 32% (range 20-41%) of the movement between the upper thorax and sacropelvis occurred cranial to T12. We therefore suggest that the term "low back" should be applied to a series of mobile vertebrae in the lower thoracic and lumbar spines and that motion of this region in the sagittal plane should be considered as the movement of an immobile upper thoracic spine relative to the sacropelvis.

Defects of pars interarticularis in athletes: a protocol for nonoperative treatment.

The purpose of this study was to report the results of a specific treatment protocol for athletes with spondylolysis or spondylolisthesis of the lumbar spine. A retrospective study with recent follow-up was performed on 82 patients treated with restriction of activity, bracing, and physical therapy. All of the patients were involved in sports at first onset of symptoms. Sixty-six patients were boys and 16 were girls. Activities involving repetitive hyperextension and/or extension rotation of the lumbar spine were described as painful in 98% of the patients. Of the 62 patients with spondylolysis, 53 (85%) had an L5 defect and nine (15%) an L4 defect (90% of these 62 patients' defects were located in the most caudad mobile vertebra). Thirty-seven patients had bilateral pars defects, and 25 had unilateral defects. Eight patients had normal roentgenograms, but these eight had abnormal bone scans. Nine patients with spondylolysis underwent posterolateral fusion. Average follow-up was 4.2 years. Fifty-two (84%) had excellent results, eight had good results, and two had fair results. Twenty patients had a spondylolisthesis: 12 were grade I, six were grade II, and two were grade III. Twelve patients (60%) required surgery; 9 had excellent results, one had good results, one had a fair result, and one had a poor result. Pars defects must be suspected in the differential of low back pain in young athletes. Oblique radiographs are frequently diagnostic; however, if the history and examination are suggestive despite normal plain films, a bone scan should be obtained. Nonoperative management of pars defects is frequently successful.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascular and vegetative spinal cord disorders in disruptions of the mobile vertebrae

Microcirculatory disorders can be a source of nerve cell pathology in spinal cord gray matter. Subluxation of a vertebra as the result of disruption in carrying capacity of an intervertebral disc due to spinal osteochondrosis is one of the trigger mechanisms for these disorders. In this condition, the richly innervated soft tissues of a certebral segment are stretched, and its receptors are the source of chronic irritation of segmentary nervous structures, including the vegetative structures. In subluxation of a vertebra, changes in the vegetative connections of spinal cord gray matter and the microcirculatory vessels arise simultaneously; this suggests interdependence between them.