Articular Fusion LSTV Types and Disc Herniations

  • Niki Matveeva Institute of Anatomy Faculty of Medicine UKIM Skopje
  • Jasmina Cabukovska University Clinic of Surgery, St. Naum Ohridski, Skopje, R.Macedonia
  • Mairja Papazova Institue of anatomy , Medical Faculty UKIM Skopje
  • Julija Zivadinovik Institue of anatomy , Medical Faculty UKIM Skopje
  • Biljana Zafirova Institue of anatomy , Medical Faculty UKIM Skopje
  • Biljana Bojadzieva Institue of anatomy , Medical Faculty UKIM Skopje
  • Biljana Trpkovska Institue of anatomy , Medical Faculty UKIM Skopje


Background: The relationship between different lumbosacral transitional vertebra (LSTV) types, disc herniations and  neural structures compromise has been sporadically reported.

Objectves: The objectives of this study was to evaluate the relationship between articular fusion LSTV types, disc herniations and  neural structures compromise.

Material and Methods: A total of 92 patients with lumbosacral radicular syndrome who underwent MRI examination of the lumbar spine were included in the study. All patients had at least one evaluated disc herniation at the last three mobile levels. These patients were separated in two groups. Study group comprised 58 patients who presented with LSTV (articular fusion type based on Castellvi classification). Additionaly this group was separated in two subgroups; 25 patients with unilateral  and 33 of them with bilateral articular fusion LSTV type. Thirty four patients without LSTV were assigned to the control group.

Results: There were significantly more disc herniations (92% vs 73.5%, p=.03) and more severe cauda equine compression (12% vs 5.9%) at the level of transition in the  LSTV unilateral articular fusion subgroup compared to the control group. At the adjacent proximal level significantly more disc herniations (93.9% vs 73.5%, p=.03) and more severe cauda equina compression (51.5% vs 14.7, p=.012) was observed in the LSTV bilateral articular fusion subgroup compared to the control group.

Conclusion: In conclusion, altered morphology and biomechanics in articular fusion LSTV types provoke disc herniations and severe cauda equina compression to occur more frequently.

Key words:  spine; lumbosacral transitional vertebra; MRI; disc herniation; cauda equina


1. Konin GP, Walz DM. Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol. 2010; 31: 1778-86.
2. Bron JL, van Royen BJ, Wuisman PI. The clinical significance of lumbosacral transitional anomalies. Acta Orthop Belg. 2007;73: 687-95.
3. Hsieh CY, Vanderford JD, Moreau SR, Prong T. Lumbosacral transitional segments : classification, prevalence, and effect on disk height. J Manipulative Physiol Ther. 2000; 23: 483-489.
4. Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebra and their relationship with lumbar extradural defects. Spine (Phila Pa 1976). 1984; 9: 493-95.
5. Quinlan JF, Duke D, Eustace S. Bertolotti’s syndrome: a cause of back pain in young people. J Bone Joint Surg [Br]. 2006; 88: 1183-6.
6. Luoma K, Vehmas T, Raininko R, et al. Lumbosacral transitional vertebra : relation to disc degeneration and low back pain. Spine. 2004; 29: 200-5.
7. Aihara T, Takahashi K, Ogasawara A, et al. Intervertebral disc degeneration associated with lumbosacral transitional vertebrae: a clinical and anatomical study. J Bone Joint Surg [Br]. 2005; 87: 687-91.
8. Otani K, Konno S, Kikuchi S. Lumbosacral transitional vertebrae and nerve-root symptoms J Bone Joint Surg [Br]. 2001; 83-B: 1137-40.
9. Fardon FD, Williams LA, Dohring JE, Murtagh R, Rothman SLG, Sze GK. Lumbar disc nomenclature: version 2.0. Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The Spine Journal. 2014; 14: 2525–2545.
10. Lee GY, Lee JW, Choi HS, Oh KJ, Kang HS. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol. 2011; 40(8): 1033-9.
11. Apazidis A, Ricart PA, Diefenbach CM, Spivak JM. The prevalence of transitional vertebrae in the lumbar spine.The Spine Journal:official journal of the North American Spine Society. 2011; 11(9): 858-62.
12. Paik NC, Lim CS, Jang HS. Numeric and morphological verification of lumbosacral segments in 8280 consecutive patients. Spine. 2013; 38(10): E573-8.

13. Nardo L, Alizai H, Virayavanich W, et al. Lumbosacral transitional vertebrae: association with low back pain. Radiology. 2012; 265: 497-503.
14. Albert HB, Briggs AM, Kent P, et al. The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain. Eur Spine. 2011; 20: 1335-62.
15. Avimadje M, Goupille P, Jeannou J, Gouthiere C, Valat JP. Can an anomalous lumbo-sacral or lumbo-iliac articulation cause low back pain? A retrospective study of 12 cases. Revue du rhumatisme (English ed). 1999; 66(1): 35-9.

16. Weber J, Ernestus RI. Transitional lumbosacral segment with unilateral transverse process anomaly (Castellvi type 2A) resulting in extraforaminal impingement of the spinal nerve: a pathoanatomical study of four specimens and report of two clinical cases. Neurosurgical review. 2010; 34(2): 143-50.
17. Abe E, Sato K, Shimada Y, Okada K, Yan K, Mizutani Y. Anterior decompression of foraminal stenosis below a lumbosacral transitional vertebra. A case report. Spine. 1997; 22(7): 823-6.
18. Ichihara K, Taguchi T, Hashida T, Ochi Y, Murakami T, Kawai S. The treatment of far-out foraminal stenosis below a lumbosacral transitional vertebra: a report of two cases. Journal of spinal disorders& techniques. 2004; 17(2): 154-7.
19. Porter NA, Lalam RK, Tins BJ, Tyrrell PN, Singh J, Cassar-Pullicino VN. Prevalence of extraforaminal nerve root compression below lumbosacral transitional vertebrae. Skeletal radiology. 2014; 43(1): 55-60.
20. Brault JS, Smith J, Currier BL. Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain. Spine (Phila Pa 1976). 2001; 26: 226–29.
21. Taskaynatan MA, Izci Y, Ozgul A, Hazneci B, Dursun H, Kalyon TA. Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain. Spine. 2005; 30(8): E210-3.

22. Yavuz U, Bayhan AI, Beng K, Emrem K, Uzun M. Low back complaints worse, but not more frequent in subjects with congenital lumbosacral malformations: a study on 5000 recruits. Acta orthop Belg. 2012; 78(5): 668-71.

23. Secer M, Muradov JM, Dalgic A. Evaluation of congenital lumbosacral malformations and neurological findings in patients with low back pain. Turkish neurosurgery. 2009; 19(2): 145-8.

24. Farshad Amacker NA, Herzog RJ, Hughes AP, Aichmair A, Farshad M. Associations between lumbosacral transitory anatomy types and degeneration at the transitional and adjacent segments. The Spine Journal. 2015; 15: 1210-16.
How to Cite
MATVEEVA, Niki et al. DISC HERNIATIONS AND CAUDA EQUINA COMPRESSION IN UNILATERAL AND BILATERAL ARTICULAR FUSION LUMBOSACRAL TRANSITIONAL ANATOMY TYPES. Journal of Morphological Sciences, [S.l.], v. 1, n. 1, p. 10-19, apr. 2018. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/14>. Date accessed: 19 june 2024.