Vertebral Anomalies Research Articles

Goldenhar syndrome: An ephialte for the anesthesiologist – What we saw was just the tip of the iceberg

Goldenhar syndrome, also called oculoauriculovertebral dysplasia, is characterized by craniofacial, central nervous system, cardiac, renal, and vertebral anomalies. It occurs due to the faulty unilateral development of vertebral arches. Patients presenting for surgery are usually in the pediatric age group. General anesthesia is the preferred mode of anesthesia considering the type of surgery, age of the patient, and vertebral anomaly in this patient group. The first and foremost consideration while anesthetizing these patients is the anticipated difficult airway. Frequently encountered airway abnormalities in these patients are micrognathia, retrognathia, mandibular dysplasia, craniovertebral anomalies leading to limited neck flexion and cervical spine instability, decreased thyromental distance, fascial asymmetry, cleft lip and palate, high arched palate, dental abnormalities, and temporomandibular joint abnormalities. Difficult airways often come disguised as syndromes, and thorough pre-operative evaluation along with preparation for the worst scenarios is a must. We have a myriad of alternative airway management equipment at our disposal. Adequate knowledge is a must for their best use.

Enhanced Recovery After Surgery (ERAS) Spine Pathways and the Role of Perioperative Checklists.

Enhanced recovery after surgery (ERAS) proposes a multimodal, evidence-based approach to perioperative care. ERAS pathways have been shown to help reduce complications, hospital length of stay (LOS), 30-day readmission rates, pain scores, and ultimately surgical costs, while improving patient satisfaction scores and outcomes in multiple surgical subspecialties [1-6]. Numerous specialties have implemented ERAS programs across the globe, providing a foundation for spine surgeons to begin the process themselves. Over the last few years, a significant number of papers have been addressing ERAS pathways for spinal surgery [7-19]. The majority have addressed the lumbar spine [9, 20-26]. The number of cervical ERAS pathways has been limited [27-29]. Many spine programs have begun the implementation of ERAS pathways, incorporating principles and interventions to various spine surgical procedures. Although differences in implementation across programs exist, there are a few common elements that promote a successful enhanced recovery approach [11, 16, 23, 25, 30-33]. All spinal ERAS pathways have three major elements, which are preoperative, perioperative, and postoperative phases. Within these phases some common elements include preoperative and intraoperative surgical checklists. Intraoperative checklist in addition to the "surgical time out" has been integrated into the workflow of most hospitals doing surgeries and have become a standard of care. The surgical checklist is designed to help reduce surgical errors and prevent wrong site/patient surgeries. Several surgical checklists have been developed throughout the years. Despite these safety protocols wrong site/level and other surgical errors continue to occur. Many cases of wrong level spine surgery (WLSS) still occur even when intraoperative imaging is performed [34, 35]. One survey reported that about 50% of spine surgeons have performed at least one WLSS during their career [36, 37]. Another survey reported that 36% of spine surgeons had performed at least one WLSS that was not recognized intraoperatively [38]. On a similar account, about 30% of spine surgery fellows have experienced wrong-site surgery [39]. From raw incidence rates, WLSS may seem rare, but these surveys show that the experience of WLSS is rather common among spine surgeons. WLSS is not yet a "never event." This may be due to poor quality of the intraoperative images, hindering subsequent level identification [34, 35, 38, 40]. Errors in interpretation of the imaging may also occur, including inconsistency in numbering vertebrae, inconsistency in landmark usage for level counting, and problems with numbering vertebrae due to lumbosacral transitional vertebrae (LSTV) and other anatomical variants [34, 38, 41-43]. This chapter will describe a framework for the development and implementation of ERAS pathway for patients undergoing spine surgery. In addition, we will propose preoperative imaging guidelines and a comprehensive spine surgical checklist to incorporate into the perioperative phase to help reduce further surgical errors and WLSS.

Evaluation of Cervico-vertebral Dimensions and Cranio-cervical Angulations in Adults with Different Vertical Growth Patterns: A Cross-sectional Cephalometric Study

Introduction: The measurement of cervical vertebrae is a valuable diagnostic aid since it provides data on skeletal maturity and potential for growth. Research suggests the existence of a relationship between dentofacial characteristics and craniocervical morphology and posture. This relationship can provide insights into the development and treatment of malocclusions, particularly malocclusions in the vertical dimension. Aim: To compare cervico-vertebral dimensions, morphology, and cranio-cervical postures in subjects with different skeletal growth patterns such as average, horizontal and vertical. Materials and Methods: The study was cross-sectional in design and was conducted for a period of two years between January 2014 and December 2016 at KLE Society’s Institute of Dental Science and Research, Bengaluru, Karnataka, India. A total of 102 lateral cephalograms were taken for the study and classified into three groups according to Frankfurt Mandibular Plane Angle (FMA angle) and Jarabak ratio as Horizontal (HR), Vertical (VR), and Average (AV) groups. Each group comprised 34 subjects (17 males, 17 females). A total of 28 morphological parameters of C3, C4, and C5 in the lateral cephalogram were measured and analysed. Each lateral cephalogram was scanned with a Konica Minolta Bighub Laser printer, and the area measurement was made with IMAGE J software to measure the area of cervical vertebrae. Oneway Analysis of Variance (ANOVA) was used to compare the various parameters between the three groups, and pair-wise comparisons were done using the Least Significant Difference (LSD) test. Student's t-test was done to assess the differences between males and females. A p-value less than 0.05 was considered statistically significant. Results: The mean chronological age of subjects was 21.2±3.14 years for the HR group, 21.3±3.78 years for the VR group, and 21±3.76 years for the AV group. There was a statistically significant difference between the three groups in the measurements of the anterior body height of C3 (ABHC3) (p=0.023), posterior Body Height of C3 (PBHC3) (p=0.007), vertical measurements of C3 (H3) (p=0.010) and (W3) (p=0.013), anterior body height of C4 (ABHC4) (p=0.010), Posterior Body Height of C4 (PBHC4) (p=0.005); H4 (p=0.002); Ratio of H4 and W4 (H4/W4) (p=0.048); area of the third cervical vertebrae (C3) (p=0.039) and area C4 (p=0.024). For cranio-cervical angulation, there were statistically significant differences found for the angle between the Nasion Sella Line (NSL) and the tangent to the Odontoid Process (NSL/OPT) (p<0.001), where the VR group had significantly larger values than the HR and AV groups. There was no significant difference found in fusion anomalies of cervical vertebrae among all three (HR, VR, and AV) groups. Conclusion: The study found that individuals with a horizontal growth pattern tend to have larger cervical vertebral dimensions compared to average and vertical growers. Individuals with a vertical growth pattern exhibited a large cranio-cervical angulation. Overall, males had larger cervical vertebral dimensions compared to females. The studied population did not exhibit any fusion anomalies.

Single Umbilical Artery and Associated Systemic Anomalies in Foetal and Perinatal Autopsy: An Observational Study

Introduction: Single Umbilical Artery (SUA) is a congenital anomaly that can occur either as an isolated finding or in association with other systemic anomalies. Several studies have reported that SUA is linked to dysplastic kidneys, ventricular septal defects, oesophageal atresia, spina bifida, diaphragmatic hernia and cystic hygromas. Therefore, investigating cases of SUA in autopsies is crucial. Aim: To estimate the frequency of SUA in foetal autopsies and determine the association between SUA and other systemic anomalies. Materials and Methods: The present ambispective observational study was conducted in the Department of Pathology, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, Karnataka, India, over a 13 year period from January 2009 to December 2021. A total of 63 cases of SUA detected during foetal autopsies were included. Factors such as age, parity and multiple births were collected where available. The hospital-based frequency of SUA was calculated as a percentage. The association between SUA and systemic anomalies was assessed using the Chi-square test. Results: A total of 1338 perinatal autopsies were performed during the study period, with SUA present in 63 (4.70%) cases. The most common associated anomaly was genitourinary defects identified in 16 (25.39%) cases. However, a statistically significant association was observed with musculoskeletal (11.11%), nervous (11.11%), and gastrointestinal system anomalies (19.04%) with a p-value of <0.0001. Conclusion: In the present study, SUA accounted for 4.70% of the foetal autopsies conducted during the study period. The most common associated anomalies were bilateral cystic kidneys, and VATER (Vertebral, Anal, Tracheo-oesophageal, and Renal anomalies) was the most common syndromic associations with SUA.

Sagittal balance analysis in young patients presenting symptomatic lumbosacral transitional vertebra, A case series

Sagittal balance analysis in young patients presenting symptomatic lumbosacral transitional vertebra, A case series

Sagittal Balance analysis in young patients presenting symptomatic Lumbosacral Transitional Vertebrae, a case series

Sagittal Balance analysis in young patients presenting symptomatic Lumbosacral Transitional Vertebrae, a case series

Spondylocostal dysostosis: A rare case report

Spondylocostal dysostosis (SCD), also known as Jarcho Levin syndrome, is a rare congenital dysostosis characterized by multiple congenital vertebral and rib anomalies. The child usually presents with respiratory distress at birth with eventual development of short trunk dwarfism. Associated congenital anomalies are rare; however, they need evaluation. We report a 6-month-old Indian girl with SCD who presented with respiratory distress and an asymmetrical small thoracic cavity. The diagnosis was made with radiographs, computed tomography scans, and magnetic resonance imaging (MRI) showing multiple rib and vertebral segmentation anomalies. We would also highlight the importance of MRI in these patients and illustrate other associated brain and spine anomalies.

Síndrome de Bertolotti. Dolor lumbar en una adolescente

Bertolotti syndrome, also called transverse megapophysis, is a congenital anomaly consisting of transitional vertebrae at the lumbosacral level, whereby the last L5 lumbar vertebra becomes “sacralized”. It is one of the causes of chronic low back pain, reaching 20% in those under 30 years of age, with few cases reported in children. A 14-year-old girl is presented with low back pain for 2 months with little response to symptomatic treatment. Complementary tests were requested, finding a transverse megapophysis in L5 in the column X-ray. The patient remains under follow-up by traumatology with analgesic and physiotherapy treatment.

Dual Growing Rods and the Apical Control Technique for Treating Congenital Early-Onset Scoliosis: Lessons Learned.

Congenital early-onset scoliosis (CEOS) is characterized by a spectrum of vertebral anomalies, including formation failures and segmentation failures at the apex segment, which makes CEOS different from other etiologies of early-onset scoliosis. To date, studies on patients who have graduated from CEOS treatment using traditional dual growing rods (TDGR) have been scarce, and the preliminary results of TDGR with or without the apical control technique (ACT) have varied. We therefore compared the final outcomes of patients with CEOS who graduated from TDGR with or without the ACT. A retrospective study of patients with CEOS who had graduated from TDGR treatment performed from 2007 to 2020 was conducted. Graduation included final fusion or observation after reaching skeletal maturity. Patients were divided into the ACT-TDGR group (apical vertebrectomy and/or hemivertebrectomy with short fusion and TDGR) and the TDGR-only group. Demographic characteristics, radiographic data, patient-reported clinical outcomes, pulmonary function, and complications were analyzed. A total of 41 patients with CEOS were enrolled: 13 in the ACT-TDGR group and 28 in the TDGR-only group. The lengthening intervals were longer in the ACT-TDGR group (mean [and standard deviation], 1.26 ± 0.66 years) than in the TDGR-only group (0.80 ± 0.27 years). The preoperative main curve was larger in the ACT-TDGR group (80.53° ± 19.50°) than in the TDGR-only group (64.11° ± 17.50°). The residual curve was comparable between groups (26.31° ± 12.82° in the ACT-TDGR group compared with 27.76° ± 15.0° in the TDGR group) at the latest follow-up. The changes in apical vertebral rotation and thoracic rotation were significantly larger in the ACT-TDGR group. Patients had comparable T1-12 and T1-S1 heights, pulmonary function, and 22-item Scoliosis Research Society (SRS-22) scores at the latest follow-up. The mean number of mechanical-related complications per patient was lower in the ACT-TDGR group (0.77 ± 0.73) than in the TDGR-only group (1.54 ± 1.43). Seventeen patients underwent final fusion. In this small-scale study, we observed that both ACT-TDGR and TDGR-only could correct the deformity while allowing for spinal growth in patients with CEOS. ACT-TDGR yielded better correction in severe cases and did not have a deleterious effect on spinal height. A large number of cases will be needed to validate the clinical value of the ACT. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Techniques for restoring optimal spinal biomechanics to alleviate symptoms in Bertolotti syndrome: illustrative case.

Lumbosacral transitional vertebrae (LSTVs) are congenital anomalies that occur in the spinal segments of L5-S1. These vertebrae result from sacralization of the lowermost lumbar segment or lumbarization of the uppermost sacral segment. When the lowest lumbar vertebra fuses or forms a false joint with the sacrum (pseudoarticulation), it can cause pain and manifest clinically as Bertolotti syndrome. A 36-year-old female presented with severe right-sided low-back pain. Computed tomography was unremarkable except for a right-sided Castellvi type IIA LSTV. The pain proved refractory to physical therapy and lumbar epidural spinal injections, but targeted steroid and bupivacaine injection of the pseudoarticulation led to 2 weeks of complete pain relief. She subsequently underwent minimally invasive resection of the pseudoarticulation, with immediate improvement in her low-back pain. The patient continued to be pain free at the 3-year follow-up. LSTVs alter the biomechanics of the lumbosacral spine, which can lead to medically refractory mechanical pain requiring surgical intervention. Select patients with Bertolotti syndrome can benefit from operative management, including resection, fusion, or decompression of the pathologic joint.

Frequency of Coexistent Spinal Segment Variants: Retrospective Analysis in Asymptomatic Young Adults.

Spinal segment variants are highly prevalent and can potentially lead to incorrect spinal enumeration and, consequently, interventions or surgeries at the wrong vertebral levels. Our aim was to assess the prevalence of spinal segment variants and to study the potential association among these variants in a population without histories of spine symptoms. Consecutive computed tomography exams of 450 young adults originally evaluated for non-spinal conditions and without a history of spinal diseases from a single institution. In addition to using descriptive statistics for reporting frequencies of spinal segment variants, the association between these variants was studied by calculating odds ratios and their 95% confidence interval. Consecutive CT exams were evaluated to determine the total number of presacral segments, presence of cervical rib, thoracolumbar transitional vertebra, iliolumbar ligament, and lumbosacral transitional vertebra. The spinal segment distribution variants (an atypical number of presacral segments or an atypical distribution of thoracolumbar vertebrae), cervical rib, thoracolumbar transitional vertebra, and lumbosacral transitional vertebra were reported in 23.8%, 4.2%, 15.3%, and 26.4% of cases in our study population. The presence of a cervical rib or a thoracolumbar transitional vertebra was associated with concurrent lumbosacral transitional vertebra (OR = 3.28; 95% CI, 1.29-8.47 and 1.87; 95% CI, 1.08-3.20, respectively). The inability to visualize the iliolumbar ligament was also associated with the presence of cervical ribs (OR = 3.06; 95% CI, 1.18-7.80). In a population of asymptomatic young adults, spinal segment variants are both highly prevalent with a high rate of coexistence. When a spinal segment variant (eg, transitional vertebra) is diagnosed, additional imaging might be considered for accurate spine enumeration before interventions or operations.

Lumbosacral transitional vertebra in 14 dog breeds in Norway: Occurrence, risk factors and association with hip dysplasia

A lumbosacral transitional vertebra (LTV) is a congenital anomaly of the spine and has been suggested to predispose to canine hip dysplasia (CHD). This retrospective, cross-sectional study investigated the prevalence of LTV and CHD among 14 dog breeds in Norway, the possible associations with risk factors, and whether LTV was a risk factor for the development of hip dysplasia. The results were based on evaluation of ventrodorsal radiographs from the CHD screening program from the Norwegian Kennel Club from February 2014 to January 2022. A total of 13,950 dogs were included in the study. For statistical analysis, CHD grades were reclassified from the official Federation Cynologique Internationale (FCI) grades into three grades: CHD free (CHD=A, B), CHD mild (CHD=C), and CHD severe (CHD=D, E). In the study sample, the overall occurrence of LTV was 18.5%, of which 32.9% were type 1, 45.7% type 2% and 21.4% type 3. The occurrence of LTV varied significantly among the included breeds, ranging from 9.5% to 46.2%. There was no association between sex and LTV. The frequencies of CHD grades were A: 43.1%; B: 31.4%; C: 18.4%; D: 6.0%; E: 1.1%. There was a statistically significant association with mild and severe CHD in dogs with LTV type 2 and LTV type 3 (P< 0.001). In the population studied, the prevalence of LTV was different among breeds. This supports initial data on the heredity of LTV and the diverse occurrence of LTV among breeds. Our results indicate that LTV type 2 and type 3 are associated with mild and severe CHD development. Therefore, this study has potentially identified an additional risk factor for the development of hip dysplasia.

Conjoined first (atlas) and second (axis) cervical vertebrae in an eastern wapiti (Cervus canadensis canadensis) from the Angel Site (1000–1400 CE, Indiana, USA)

AbstractAtlantoaxial abnormalities are rarely documented among wild animals. Many defects of segmentation in the spine are hereditary in domestic species and humans. Here, we present a block vertebra in an eastern wapiti (Cervus canadensis canadensis) from the Angel Site (12Vg1) in southern Indiana (USA) dating to 1000–1400 CE. Diagnosis used macroscopic and radiographic examination. Evidence of inflammatory response and eburnation point to functional compromise. Recorded pathologies of this nature are underrepresented in the past and present. We suggest this specimen from an adult wapiti species represents a female as this condition would have been more debilitating in an antlered stag limiting the possibility of living well into adulthood.

Effect of photoperiod regime on the growth performance, survival, swim bladder inflation and vertebral anomalies of pikeperch (Sander lucioperca) larvae in recirculating aquaculture systems (RAS)

ABSTRACT The effect of photoperiod on the growth performance, survival rate, swim bladder inflation (SBI) and presence of vertebral anomalies was evaluated in pikeperch larvae reared under intensive production in a recirculating system (RAS). Three different photoperiods were tested from 1 to 30 days post hatch, 12:12 LD, 16:8 LD and 24:0 LD. Larvae were stocked with an initial density of 100 larvae per liter, light intensity of 100 lx and 16.0°C water temperature. The SGR among treatments ranged between 11.17 and 12.04% day−1. The highest survival rate (56.7 ± 2.4%) was found in 24:0 LD with a negative effect on the number of larvae with SBI. The highest presence of vertebral anomalies at 30 dph was found in 24:0 LD (40.8 ± 8.2%) compared to 12:12 LD (2.5 ± 1.4%) and 16:8 LD (1.7 ± 1.6%). These results suggest that constant light compromises culture of pikeperch larvae in RAS. A 16:8 LD photoperiod seems suitable for the growth performance, SBI and low vertebral anomalies at this life stage.

Cephalometric Evaluation of the Relationship Between Cervical Vertebral Morphology and Anomalies and the Cranial Base Angle in Different Facial Types and Skeletal Classes

This study examines the morphology and common anomalies of the cervical vertebrae in different skeletal classes and facial types. This cross-sectional study was conducted on 137 lateral cephalometric images of patients aged 18-55 years. The images were evaluated for fusion and posterior arch deficiency as the two most common anomalies along with cervical vertebral morphology (dense angle, the height of the posterior arch of the atlas, the external anterior posterior diameter of the atlas, and the cranial base angle). Data were categorized into three skeletal classes based on the Wits analysis and the ANB angle and also three facial types based on the SN-MP angle. These calculations were performed in SPSS 22 at the significance level of P&lt;0.05. The height of the posterior arch of the atlas was directly and significantly related to age and increased with it. The mean external anterior posterior diameter of C1 was higher in men and in the hypodivergent group. As for the other factors, including cervical spine anomalies, no significant relationship was observed with age, sex, skeletal classes, facial types, and the cranial base angle. Moreover, the mean morphology of the cervical spine was not significantly associated with skeletal classes. Based on the results, the height of the posterior arch of the atlas was associated with age and increased along with it. Moreover, the mean external anterior posterior diameter of the atlas was greater in men and in hypodivergent individuals.

Axial T1-weighted imaging of the lumbar spine: a redundancy or an asset?

To determine the diagnostic value of axial T1-weighted imaging for patients suffering from lower back pain. In this retrospective study, 100 consecutive lumbar spine MRIs obtained in patients with chronic low back pain were reviewed in two sessions: First, readers viewed core sequences (sagittal T1-weighted, STIR and T2-weighted, and axial T2-weighted) with axial T1-weighted sequences, and second, readers viewed cores sequences alone. Readers recorded the presence of disc degeneration, nerve root compromise, facet joint arthritis, and stenosis at each lumbar spine level as well as the presence of lipoma of filum terminale (LFT), spondylolisthesis, transitional vertebrae, and fractures. The McNemar, Wilcoxon signed-rank, and student T tests were utilized. For 100 studies, 5 spine levels were evaluated (L1-L2 through L5-S1). There were cases of disc disease (444/500 bulges, 56/500 herniations), nerve root compromise (1/500 nerve enlargement, 36/500 contact only, 20/500 displacement or compression), facet arthritis (438/500), stenosis (58/500 central canal, 64/500 lateral recess, 137/500 neuroforaminal), 6/100 LFTs, and other abnormalities (58/500 spondylolisthesis, 10/100 transitional vertebrae, 10/500 fracture/spondylolysis). There was no difference in diagnostic performance between the interpretation sessions (with and without axial T1-weighted imaging) at any level (p > 0.05), although four small additional LFTs were identified with axial T1-weighted imaging availability. There was no clinically significant difference in the interpretation of lumbar spine MRI viewed with and without axial T1-weighted imaging, suggesting that the axial T1-weighted sequence does not add diagnostic value to routine lumbar spine MRI.

Effect of lumbosacral transitional vertebrae on sagittal balance of lumbo-pelvic complexity assessed by quantitative whole-body CT imaging.

The variation at the lumbosacral junction certainly results in occult alignment changes in the lumbo-pelvic complexity (LPC). This retrospective case-control study aims to investigate the influences of lumbosacral transitional vertebrae (LSTV) on sagittal lumbo-pelvic balance assessment and provide some recommendations for preoperative imaging evaluation. Based on whole-body computed tomography (CT) images, a total of 210 individuals with complete segmentation anomalies of LSTV were included and divided into 23 presacral vertebrae (PSV) (sacralization, n=102), 25 PSV (lumbarization, n=108). The control group with 24 PSV (normal, n=100) was matched by age and gender. Sagittal lumbo-pelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), sacral table angle (STA), sacral kyphosis (SK), and pelvic radius (PR) were measured at the ontogenetical S1 (Ontog S1) level and the morphological S1 (Morph S1), respectively. These parameters were compared using t-test, Kruskal-Wallis H test and post hoc test. Spearman's rank correlation coefficient and linear regression were used to investigate the association of lumbo-pelvic parameters with LSTV types and measurement levels. All the parameters at the Ontog S1 differed significantly from those at the Morph S1 (all P<0.001). At the Ontog S1 level, PI, PT, SS, and LL were negatively correlated with vertebrae counts; SK and PR were positively correlated with vertebrae counts (all P<0.001). Instead, reverse results were obtained at the Morph S1 level. The measurement level and vertebrae counts were independent influence factors for the measurement of PI, PT, SS, SK, and PR (all P<0.05). Compared with the measured values of the matched controls, the variability of most lumbo-pelvic parameters (PI, SS, LL, STA, SK, PR values of 25 PSV subgroup, and PI, PT, SS, LL, STA values of 23 PSV subgroup) at the Morph S1 level were significantly smaller than that at the Ontog S1. The measurements of PT, SS, LL, and PR were less influenced by the measurement level and vertebrae counts than those of PI and SK. Morph S1 is more recommended for the measurements of most lumbo-pelvic parameters in patients with LSTV. The parameters (PT, SS, LL, STA, PR) are shown more stable and recommended to help reduce the effects caused by LSTV.

The influence of lumbosacral transitional vertebrae on lumbar lordosis and the angle of pelvic incidence.

Pelvic incidence and lumbar lordosis have only normative values for spines comprising five lumbar and five sacral vertebrae. However, it is unclear how pelvic incidence and lumbar lordosis are affected by the common segmentation anomalies at the lumbo-sacral border leading to lumbosacral transitional vertebrae, including lumbarisations and sacralisations. In lumbosacral transitional vertebrae it is not trivial to identify the correct vertebral endplates to measure pelvic incidence and lumbar lordosis because ontogenetically the first sacral vertebra represents the first non-mobile sacral segment in lumbarisations, but the second segment in sacralisations. We therefore assessed pelvic incidence and lumbar lordosis with respect to both of these vertebral endplates. The type of segmentation anomaly was differentiated using spinal counts, spatial relationship with the iliac crest and morphological features. We found significant differences in pelvic incidence and lumbar lordosis between lumbarisations, sacralisations and the control group. The pelvic incidence in the sacralised group was mostly below the range of the lubarisation group and the control group when measured the traditional way at the first non-mobile segment (30.2°). However, the ranges of the sacralisation and lubarisation groups were completely encompassed by the control group when measured at the ontogenetically true first sacral vertebra. The mean pelvic incidence of the sacraliation group thus increased from 30.2° to 58.6°, and the mean pelvic incidence of the total sample increased from 45.6° to 51.2°, making it statistically indistinguishable from the control sample, whose pelvic incidence was 50.2°. Our results demonstrate that it is crucial to differentiate sacralisations from lumbarisation in order to assess the reference vertebra for pelvic incidence measurement. Due to their significant impact on spino-pelvic parameters, lumbosacral transitional vertebrae should be evaluated separately when examining pelvic incidence and lumbar lordosis.

Functional and radiological outcomes following craniovertebral junction surgery.

Craniovertebral junction (CVJ) pathologies include atlantoaxial instability/deformities resulting in myelopathy, respiratory failure, and even death. Here, we describe the indications, preoperative planning, and intra-operative/postoperative complications following surgical management of CVJ anomalies. A prospective analysis of 34 patients with CVJ pathology was evaluated between 2015 and 2022. Their various etiologies included atlantoaxial instability, trauma, tuberculosis, Down's syndrome, Morquio syndrome, os odontoideum, and atlantoaxial abnormalities. Clinical outcomes were assessed using the American spinal injury association (ASIA) impairment scale score and Benzel's modified Japanese Orthopedic Association (mJOA) score. Surgical assessments included length of hospital stay, operative time, blood loss, and intraoperative postoperative complications. Radiological parameters included fusion (i.e., implant loosening/implant failure), preoperative/ postoperative atlanto-dens interval (ADI), clivus canal angle (CCA), and space available for cord (SAC). Five patients were managed conservatively, while 29 patients had surgery. Operations included occipitocervical fusion (14 patients), C1-2 fusion (10 patients), C1-2 transarticular screw fixation (four patients), and one patient underwent anterior corpectomy decompression/fusion. Seven patients had vertebral artery anomalies, and 13 patients had atlantoaxial abnormalities. At the final follow-up, atlantoaxial instability (i.e., mean preoperative ADI of 6.6 ± 2.3 mm) was restored to 4.2 ± 0.6 mm, significant cord compression (i.e., with mean SAC of 8.3 ± 2.9 mm) was relieved to 17.2 ± 1.6 mm, and the mean preoperative CCA (i.e., 130.2 ± 15.3) was improved to 143.3 ± 8.3°. There was also a statistically significant improvement in the ASIA scale and mJOA score. Surgical management of CVJ abnormalities requires expertise and meticulous planning to avoid devastating complications such as wound dehiscence and catastrophic vertebral artery injury.

The prevalence of anomalies in the lumbar spine in the Turkish male population

Aims: It was aimed to determine the prevalence of lumbosacral anomalies in young male population.&#x0D; Methods: 56.798 male patients, between 18-49 years old, were included in this study during their medical screening in Dışkapı Yıldırım Beyazıt Training and Research Hospital from July 2016-July 2020. The presence of spina bifida occulta (SBO) and transitional vertebrae (TV) anomalies were recorded in the candidates. SBO patients were evaluated according to their S1 and L5 origins, and TV patients were evaluated separately according to sacralization and lumbarization. We identified transitional vertebrae by counting down from the last thoracic vertebra on the AP X-rays, then if necessary looking at the lateral view for confirmation. If hypoplastic ribs were identified, the vertebra immediately beneath would be designated as L1. Castellvi types I, II, III, and IV were included as transitional states.&#x0D; Results: 56798 patients were evaluated retrospectively. The mean age of the patients was 23.28 (18-49 years). Radiological anomalies were detected in 2577 (4.5%) of 56798 cases. No radiological anomaly was observed in other cases. Spina bifida occulta was detected in 1478 (2,6%) patients. Lumbosacral transitional vertebrae were detected in 1099 cases (1.9%). 745 (1.3%) of these anomalies are sacralization and 354 (0.6%) of them are lumbalization.&#x0D; Conclusion: In the light of this information, we think that knowing the frequency of lumbosacral anomalies, especially LSVT, in our society should be considered in the evaluation before spinal surgery operations.