Differentiation between Symptomatic and Asymptomatic Extraforaminal Stenosis in Lumbosacral Transitional Vertebra: Role of Three-Dimensional Magnetic Resonance Lumbosacral Radiculography

Abstract

ObjectiveTo investigate the role of lumbosacral radiculography using 3-dimentional (3D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra.Materials and MethodsThe study population consisted of 18 patients with symptomatic (n = 10) and asymptomatic extraforaminal stenosis (n = 8) in lumbosacral transitional vertebra. Each patient underwent 3D coronal fast-field echo sequences with selective water excitation using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3D MR rendered images of the lumbosacral spine.ResultsTen cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases, while swelling of the nerve roots was seen in eight cases at the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in any cases with asymptomatic extraforaminal stenosis.ConclusionResults from 3D MR lumbosacral radiculography Indicate the indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on these findings, 3D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis with lumbosacral transitional vertebra.

Are Spinal or Paraspinal Anatomic Markers Helpful for Vertebral Numbering and Diagnosing Lumbosacral Transitional Vertebrae?

“…The association of low back pains with LSTV, referred to as "Bertolotti's syndrome", is controversial. However, there may be symptoms originating from the degeneration of the anomalous articulation, facet joint arthrosis and nerve root compression between the broadened transverse process of the last lumbar segment and the sacral ala ( 3 , 12 , 13 ). Additionally, there are studies which reported increased incidences of disc degeneration and disc herniation above the LSTV ( 2 , 8 - 10 , 13 , 14 ).…”

The Impact of Lumbosacral Transitional Vertebrae on Therapeutic Outcomes of Transforaminal Epidural Injection in Patients with Lumbar Disc Herniation

“…The causative factors for LDH include disc degeneration, trauma, and anatomical abnormalities such as lumbosacral transitional vertebrae (LSTV). LSTV, which includes sacralization or lumbarization at the lumbosacral junction, has been recognized as a causative factor for LDH and is associated with several problems, including an increased risk for advanced disc degeneration or disc herniation, altered nerve root direction or functioning, facet joint arthrosis,, and concomitant cervical ribs . Although some studies have evaluated the clinical impact of LSTV, few have attempted to determine an effective conservative treatment method for LDH presenting concurrently with LSTV, and none have evaluated whether the presence of LSTV influences the therapeutic outcomes.…”

A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome

“…These radiographic findings were distinctively absent in cases of asymptomatic extraforaminal stenosis. 82 Resection of a right-sided unilateral anomalous lumbosacral articulation provided 90% relief of left low back pain and complete relief of left leg symptoms in 1 patient with a contralateral symptomatic L6-S1 facet joint. The authors suggested that the patient's pain was not associated with the anomalous articulation itself, but was probably due to additional stress placed on the normal contralateral joint.…”