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ObjectivesTo assess the prevalence of lumbosacral transitional vertebra (LSTV) and associated spinal degenerative changes on abdominal CT scans in Caucasian population.Material and methodsA total of 3855 abdominal CT scans of the year 2017 from a single hospital were retrospectively assessed for LSTV, disc degeneration (DD), and facet joint degeneration (FD). An age- and sex-matched 150-subject control group without LSTV was picked at random. Multivariable logistic regression was used for the analysis.ResultsLSTV was found in 1101 (29%) scans: Castellvi type I in 68%, type II in 16%, type III in 13%, and type IV in 3% of scans. Age- and sex-adjusted prevalence of DD was significantly higher in Castellvi type II and III groups at multiple lumbar levels, and in IV group at L4/5 than in control group (p < 0.001–0.034). At L5/S1, the prevalence of DD was significantly higher in the control group than in type II, III, or IV groups (p < 0.001–0.017). After combining Castellvi types II, III, and IV into one group, significant differences were found at all lumbar levels except L2/3 (p < 0.001–0.016). Prevalence of FD was significantly higher at L4/5 in Castellvi groups I, II, and III than in the control group (p < 0.001–0.002). When Castellvi types II, III, and IV were combined into one group, significant differences were found at lumbar levels L2/3, L3/4, and L4/5 (p < 0.001–0.021).ConclusionLumbosacral vertebrae of Castellvi types II, III, and IV are associated with greater lumbar degeneration, warranting meticulous evaluation of spinal anatomy, even on CT.Key Points• Lumbosacral transitional vertebra is a common incidental finding on abdominal CT scans with a high prevalence of 29%.• When assessing whole lumbar spine, lumbosacral vertebrae of Castellvi types II, III, and IV were associated with greater lumbar degeneration, warranting careful evaluation of the lumbar spine on abdominal CT scans.

Purpose To identify the clinical and radiological outcomes in the coronal and sagittal planes after treatment of congenital complex lumbosacral hemivertebrae (LSHV) with or without posterior concave reconstruction. Methods We retrospectively reviewed a consecutive series of patients with congenital LSHV deformities treated by posterior-only hemivertebra resection. The minimum follow-up was 2 years. The patients were divided into a concave-cage group and a non-cage group. The radiographic and clinical results were compared between the two groups. Results Forty patients were categorized into the cage group ( n  = 14) and non-cage group ( n  = 26). At the end of the propensity score matching analysis, 14 patients from the cage group were matched to 14 patients in the non-cage group. The lumbosacral curve and thoracolumbar/lumbar curve improved significantly in both groups at the final postoperative follow-up ( P  < 0.001), and the lumbosacral curve at the final follow-up was remarkably lower in the cage than non-cage group. The correction rates of the lumbosacral curve and thoracolumbar/lumbar curve were significantly higher in the cage than non-cage group. The lower lumbar lordosis improved significantly in both groups at the final postoperative follow-up ( P  < 0.05), and the lower lumbar lordosis at the final follow-up and its correction were remarkably higher in the cage than non-cage group (both P  < 0.05). Conclusions Posterior column reconstruction with insertion of a concave cage may achieve a higher correction rate of large lower lumbar lordosis and lumbosacral coronal deformity, attain better sagittal balance, and have fewer complications related to implant failure than posterior-only hemivertebra resection in patients with congenital LSHV.

Background 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 (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. Methods Patients 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. Results A 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. Conclusion Although 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.

Background and Objectives: The sacrum is formed by five fused vertebrae and connects the lumbar spine to the coccyx. It has four pairs of foramina for sacral nerves and shows important anatomical variations. This study aims to analyze the frequency of atypical sacral morphology in the Korean population using 3D reconstruction of postmortem computed tomography (PMCT) images, and to provide a systematic classification and morphological characterization. Materials and Methods: A total of 29 PMCT datasets (10 males, 19 females) from the National Forensic Service were used to generate 3D sacral models with Mimics software for the analysis of atypical sacral morphology. Key morphometric parameters, including sacral width (SW), sacral length (SL), sacral foramina distances (SFD1, SFD2), sacral vertebral heights (SH1, SH2), sacral curvature (SC), and sacral index (SI), were measured. Sacral foramina were categorized into three groups based on completeness, and auricular surfaces were classified into three types according to their vertical position. Results: Median values for sacral dimensions were as follows: SW 95.3 mm, SL 118.6 mm, SFD1 36.1 mm, SFD2 28.8 mm, SH1 28.0 mm, SH2 29.7 mm, SC 0.92, and SI 0.78. Sacral foramina variations were identified in 12 of 29 cases (41.4%) as incomplete, including one case with an incomplete upper opening. No significant sex-based differences were found in foramen or auricular surface types, although females showed higher values for SW and SI (SW: 97.2 mm, SI: 0.86). Correlation analysis revealed positive associations between SL and both stature (r = 0.635) and weight (r = 0.645), and negative correlations between SI and stature (r = −0.663), SL (r = −0.921), and SC (r = −0.845). Two cases (6.8%) exhibited sacralization, while the remaining 25 cases had the configuration of five lumbar vertebrae and six sacral segments. Conclusions: Our findings support the notion that atypical segmentation patterns are more prevalent than sacralization. Atypical sacral morphology was observed in 29 cases (19.8%), most commonly involving a normal lumbar spine with six sacral segments. These findings highlight the relevance of sacral variation in clinical and anatomical contexts.

Background Percutaneous iliosacral screw placement is the standard procedure for fixation of posterior pelvic ring lesions, although a transsacral screw path is being used more frequently in recent years owing to increased fracture-fixation strength and better ability to fix central and bilateral sacral fractures. However, biomorphometric data for the osseous corridors are limited. Because placement of these screws in a safe and effective manner is crucial to using transsacral screws, we sought to address precise sacral anatomy in more detail to look for anatomic variation in the general population. Questions/purposes We asked: (1) What proportion of healthy pelvis specimens have no transsacral corridor at the level of the S1 vertebra owing to sacral dysmorphism? (2) If there is no safe diameter for screw placement in the transsacral S1 corridor, is an increased and thus safe diameter of the transsacral S2 corridor expected? (3) Are there sex-specific differences in sacral anatomy and are these correlated with known anthropometric parameters? Methods CT scans of pelves of 280 healthy patients acquired exclusively for medical indications such as polytrauma (20%), CT angiography (70%), and other reasons (10%), were segmented manually. Using an advanced CT-based image analysis system, the mean shape of all segmented pelves was generated and functioned as a template. On this template, the cylindric transsacral osseous corridor at the level of the S1 and S2 vertebrae was determined manually. Each pelvis then was registered to the template using a free-form registration algorithm to measure the maximum screw corridor diameters on each specimen semiautomatically. Results Thirty of 280 pelves (11%) had no transsacral S1 corridor owing to sacral dysmorphism. The average of maximum cylindrical diameters of the S1 corridor for the remaining 250 pelves was 12.8 mm (95% CI, 12.1–13.5 mm). A transverse corridor for S2 was found in 279 of 280 pelves, with an average of maximum cylindrical diameter of 11.6 mm (95% CI, 11.3–11.9 mm). Decreasing transsacral S1 corridor diameters are correlated with increasing transsacral S2 corridor diameters (R value for females, −0.260, p < 0.01; for males, −0.311, p < 0.001). Female specimens were more likely to have sacral dysmorphism (defined as a pelvis without a transsacral osseous corridor at the level of the S1 vertebra) than were male specimens (females, 16%; males, 7%; p < 0.003). Furthermore female pelves had smaller-corridor diameters than did male pelves (females versus males for S1: 11.7 mm [95% CI, 10.6–12.8 mm] versus 13.5 mm [95% CI, 12.6–14.4 mm], p < 0.01; and for S2: 10.6 mm [95% CI, 10.1–11.1 mm] versus 12.2 mm [95% CI, 11.8–12.6 mm ], p < 0.0001). Conclusions Narrow corridors and highly individual, sex-dependent variance of morphologic features of the sacrum make transsacral implant placement technically demanding. Individual preoperative axial-slice CT scan analyses and orthogonal coronal and sagittal reformations are recommended to determine the prevalence of sufficient-sized osseous corridors on both levels for safe screw placements, especially in female patients, owing to their smaller corridor diameters and higher rate of sacral dysmorphism.

Introduction Normal spino-pelvic values for patients with lumbarization of S1 have not been described in the literature. Presented are the normal values for this population group, the prevalence of S1 lumbarization, and the correlation between pelvic incidence (PI) and lumbar lordosis (LL) in this group. Methods Two databases of asymptomatic patients were combined to identify 11 patients with the lumbarization of S1. The whole spine images were used to measure the true prevalence rate. Lumbar 3D EOS models were built to measure spino-pelvic parameters for the lumbarization group compared to the asymptomatic population. Seven patients appeared at first to have six lumbar vertebrae, but counting caudally from C2 showed this was not the case. Results 11/268 patients demonstrated the lumbarization of S1 to give a true prevalence rate of 4.1 %. The lumbarization group demonstrated a statistically significant difference with regard to PI, PT, and SS, and total lordosis measured from superior endplate of L1 to the superior endplate of the first fixed sacral segment. L6I was not significantly correlated to lordosis; however, PI did have a significant correlation with lordosis. Lordosis could be estimated in this group by the equation: LL = 1.16 × PI - 19.39 . Conclusion Incomplete imaging of the spine may lead to false estimation of the prevalence of lumbarization. Patients with lumbarization have higher lordosis values and lordosis can now be estimated during pre-operative planning for this group.

Introduction Lumbosacral hemivertebra poses a unique problem because it can cause gross imbalance and progressive compensatory thoracolumbar deformity. Previous studies have reported lumbosacral hemivertebra resection through a combined anterior and posterior approach, but there have been no reports on the results and complications of hemivertebra resection via a posterior-only procedure and short fusion with large series of patients. Materials and methods This retrospective study of a prospective collected database comprises a consecutive series of 14 congenital scoliosis due to lumbosacral hemivertebra treated by 1-stage posterior hemivertebra resection with short segmental fusion, with at least a 2-year follow-up period (24–144 months). Surgical reports and patient charts were reviewed. Radiographic evaluation included measured changes in segmental scoliosis and lordosis, compensatory scoliosis, thoracic kyphosis, lumbar lordosis, and trunk shift. Quality of life data from Scoliosis Research Society (SRS)-22 questionnaires were also collected. Results Our results showed that the mean follow-up period was 38.4 months. The mean fusion level was 3.2 segments. Mean operation time was 207.8 min with the average blood loss of 235.7 ml. The mean segmental scoliosis was 30° preoperatively, 5° postoperatively (83 % correction rate), and 4° (87 %) at the latest follow-up. The compensatory coronal curve of 30° was spontaneously corrected to 13° at most recent follow-up. Trunk shift was significantly improved on both coronal (63 %) and sagittal plane (58 %) after the surgery, and kept stable during the follow-up. The total SRS-22 score, the self-image domain score and the satisfaction domain score demonstrated significant improvement compared with preoperative status. Only one intra-operative complication was observed, a pedicle fracture. Conclusions In summary, our results showed that one-stage HV resection and short segment fusion by a posterior approach can offer excellent scoliosis correction and trunk shift improvement without neurological complications, while saving motion segments as much as possible. This strategy is not only corrective of the deformity but also preventive of compensatory curve progression, thus avoiding long lumbar fusion.

Caudal regression syndrome (CRS) is a malformation that occurs during the fetal period, and is mainly characterized by the incomplete development of the spinal cord (SC), which is often accompanied by other developmental abnormalities. The present study was performed in a 2-month-old boy with CRS, born to a type I diabetic mother, who presented interruption of the SC at the L5–L4 level, pelvic dislocation, sacral agenesis, hypoplastic femurs, lack of innervation of the lower limbs (spastic paraplegia), and a neurogenic bladder and bowel. Given the positive results we obtained in a previous study in a similar case, this patient was treated with GH (0.04 mg/kg/day, 5 days/week), melatonin (20 mg/day), and rehabilitation. The treatment only lasted 18 months, due to family problems. Blood tests and physical examinations were performed every 3 months initially and then every 6 months. Interestingly, despite GH administration, the child presented low plasma glucose and IGF-I values, which did not increase throughout the treatment, although there was significant growth of the patient, also indicated by elevated plasma alkaline phosphatase values. At the end of treatment, the gross motor function test (GMFM)-88 score increased from 0.93 (on admission) to 47.94. Sensory responses appeared in the lower limbs, and the patient was able to move his leg muscles in all directions and control his sphincters. Ten months after discharge, the patient was able to walk only with the aid of a back walker. GH treatment did not produce any adverse effects. In summary, despite the short duration of treatment, GH plus rehabilitation has been useful in innervating distal areas below the level of the incomplete spinal cord in CRS. GH likely acted on ependymal neural stem cells, as the hormone does on neurogenic niches in the brain, and rehabilitation helped achieve near-full functionality.

This report describes a 32-year-old primigravida diagnosed with bilateral anterior sacral meningoceles without bony defect of the sacrum during pregnancy. The patient remained asymptomatic throughout the pregnancy, with regular monitoring via transvaginal ultrasound and MRI. An elective cesarean section was planned at 38 weeks. However, the patient presented in obstructed labor at 42 weeks and underwent an emergency cesarean section, resulting in the birth of a healthy infant. This case is unique as it involves bilateral anterior meningoceles without sacral anomalies. Anterior sacral meningoceles are rare findings in pregnancy. Anterior sacral meningoceles are either congenital with bony defect of the sacrum or acquired lesions due to connective tissue disorders characterized by the herniation of the meninges through the sacral foramina. In pregnancy, these lesions pose unique challenges due to potential complications such as rupture, infection, or obstructed labor. Management strategies vary, and individualized approaches with close monitoring and patient counseling are crucial in determining the appropriate mode and timing of delivery.

Introduction Sacral agenesis (SA) includes a range of clinical presentations of varying severity, with implications for function and quality of life (QoL). Diagnosis is often made perinatally, and prognostic discussions become an important aspect of parental counselling. This study engaged SA sufferers and their caregivers to obtain objective, long-term patient reported outcome data. Method Patients with radiologically confirmed SA from a single tertiary spinal unit underwent retrospective medical record review. Patients were then contacted by telephone to complete QoL questionnaires including EQ-ED-5L for adults and EQ-ED-Y for < 16-year-olds. Additional information including Renshaw grade, employment, living situation and bladder function was also collected. Results Twenty-six patients with SA were identified. Mean age is 23.35 years (range 0.92–63.53), 13 M:17F. Renshaw grade ranged from 1 to 4. Sixty-eight percent had associated kyphoscoliotic deformities. The majority (70%) had either impaired or absent bladder control, and 80% need walking aids to mobilise. Twenty patients completed the questionnaire (10 adults and 10 < 16-year-olds). Mean EQ-ED-5L index for adults was +0.474 (range −0.1 to +0.089, 1 = best), with a lower mean value of +0.287 (range −0.54 to +1) for the < 16-year cohort. Those undergoing spinal fusion procedures had significantly lower scores (−0.08 v +0.44, p  = 0.022). Conclusion This study provides an objective record of the QoL of individuals with SA, illustrating a wide variety of outcomes, with differences between younger and older individuals which may reflect the results of a long-term adaptive process. The implications for individuals should be carefully tailored to the specific deformity and the likely underlying neurological deficits.