Skip to main content

Association of spinal anomalies with spondylolysis and spina bifida occulta

Abstract

Purpose

To investigate the association of spinal anomalies with lumbar spondylolysis and spina bifida occulta (SBO).

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Bertolotti M (1917) Contributo alla conoscenza dei vizi differenzazione regionale del rachide con speciale riguardo all assimilazione sacrale della V. lombare. Radiol Med (Torino) 4:113–144

    Google Scholar 

  2. Nakagawa T, Hashimoto K, Tsubakino T, Hoshikawa T, Inawashiro T, Tanaka Y (2017) Lumbosacral transitional vertebrae cause spinal level misconception in surgeries for degenerative lumbar spine disorders. Tohoku J Exp Med 242:223–228. https://doi.org/10.1620/tjem.242.223

    Article  PubMed  Google Scholar 

  3. Wigh RE, Anthony HF Jr (1981) Transitional lumbosacral discs. Probability of herniation. Spine (Phila Pa 1976) 6:168–171

    CAS  Article  Google Scholar 

  4. Konin GP, Walz DM (2010) Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol 31:1778–1786. https://doi.org/10.3174/ajnr.A2036

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. Castellvi AE, Goldstein LA, Chan DP (1984) Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976) 9:493–495

    CAS  Article  Google Scholar 

  6. Luoma K, Vehmas T, Raininko R, Luukkonen R, Riihimaki H (2004) Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine (Phila Pa 1976) 29:200–205. https://doi.org/10.1097/01.BRS.0000107223.02346.A8

    Article  Google Scholar 

  7. Becker L, Ziegeler K, Diekhoff T, Palmowski Y, Pumberger M, Schomig F (2021) Musculature adaption in patients with lumbosacral transitional vertebrae: a matched-pair analysis of 46 patients. Skeletal Radiol. https://doi.org/10.1007/s00256-021-03722-x

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sugiura K, Morimoto M, Higashino K, Takeuchi M, Manabe A, Takao S, Maeda T, Sairyo K (2021) Transitional vertebrae and numerical variants of the spine : prevalence and relationship to low back pain or degenerative spondylolisthesis. Bone Joint J 103-B:1301–1308. https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-1760.R1

    Article  PubMed  Google Scholar 

  9. Sakai T, Sairyo K, Takao S, Nishitani H, Yasui N (2009) Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects. Spine (Phila Pa 1976) 34:2346–2350. https://doi.org/10.1097/BRS.0b013e3181b4abbe

    Article  Google Scholar 

  10. Yamada A, Sairyo K, Shibuya I, Kato K, Dezawa A, Sakai T (2013) Lumbar spondylolysis in juveniles from the same family: a report of three cases and a review of the literature. Case Rep Orthop 2013:272514. https://doi.org/10.1155/2013/272514

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yurube T, Kakutani K, Okamoto K, Manabe M, Maeno K, Yoshikawa M, Sha N, Kuroda R, Nishida K (2017) Lumbar spondylolysis: a report of four cases from two generations of a family. J Orthop Surg (Hong Kong) 25:2309499017713917. https://doi.org/10.1177/2309499017713917

    Article  Google Scholar 

  12. Brea CM, Munakomi S (2021) Spina Bifida. In: StatPearls. Treasure Island (FL)

  13. Tsukagoshi Y, Kamegaya M, Tatsumura M, Tomaru Y, Kamada H, Morita M, Saisu T, Nomura S, Ikezawa Y, Yamazaki M (2020) Characteristics and diagnostic factors associated with fresh lumbar spondylolysis in elementary school-aged children. Eur Spine J 29:2465–2469. https://doi.org/10.1007/s00586-020-06553-x

    Article  PubMed  Google Scholar 

  14. Aoyagi M, Naito K, Sato Y, Kobayashi A, Sakamoto M, Tumilty S (2020) Identifying acute lumbar spondylolysis in young athletes with low back pain: retrospective classification and regression tree analysis. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000003922

    Article  Google Scholar 

  15. Ramakrishna VAS, Chamoli U, Viglione LL, Tsafnat N, Diwan AD (2018) The role of sacral slope in the progression of a bilateral spondylolytic defect at L5 to spondylolisthesis: a biomechanical investigation using finite element analysis. Global Spine J 8:460–470. https://doi.org/10.1177/2192568217735802

    Article  PubMed  Google Scholar 

  16. Oh YM, Choi HY, Eun JP (2013) The comparison of sagittal spinopelvic parameters between young adult patients with L5 spondylolysis and age-matched control group. J Korean Neurosurg Soc 54:207–210. https://doi.org/10.3340/jkns.2013.54.3.207

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tang C, Liao YH, Tang Q, Ma F, Wang Q, Zhong J (2021) What is the difference in pedicle morphology of the fifth lumbar vertebra between isthmic and degenerative L5–S1 spondylolisthesis? An anatomic study of 328 patients via multi-slice spiral computed tomography. Eur Spine J. https://doi.org/10.1007/s00586-021-06884-3

    Article  PubMed  Google Scholar 

  18. Morimoto M, Sakai T, Goto T, Sugiura K, Manabe H, Tezuka F, Yamashita K, Takata Y, Chikawa T, Sairyo K (2019) Is the scotty dog sign adequate for diagnosis of fractures in pediatric patients with lumbar spondylolysis? Spine Surg Relat Res 3:49–53. https://doi.org/10.22603/ssrr.2017-0099

    Article  PubMed  Google Scholar 

  19. Park SK, Park JG, Kim BS, Huh JD, Kang H (2016) Thoracolumbar junction: morphologic characteristics, various variants and significance. Br J Radiol 89(1064):20150784. https://doi.org/10.1259/bjr.20150784

    Article  PubMed  PubMed Central  Google Scholar 

  20. Farshad-Amacker NA, Lurie B, Herzog RJ, Farshad M (2014) Interreader and intermodality reliability of standard anteroposterior radiograph and magnetic resonance imaging in detection and classification of lumbosacral transitional vertebra. Spine J 14:1470–1475. https://doi.org/10.1016/j.spinee.2013.08.048

    Article  PubMed  Google Scholar 

  21. O’Driscoll CM, Irwin A, Saifuddin A (1996) Variations in morphology of the lumbosacral junction on sagittal MRI: correlation with plain radiography. Skeletal Radiol 25:225–230

    CAS  Article  Google Scholar 

  22. Wigh RE (1980) The thoracolumbar and lumbosacral transitional junctions. Spine (Phila Pa 1976) 5:215–222

    CAS  Article  Google Scholar 

  23. Chepurin D, Chamoli U, Sheldrick K, Lapkin S, Scott D, Kuan J, Diwan AD (2019) Bony stress in the lumbar spine is associated with intervertebral disc degeneration and low back pain: a retrospective case-control MRI study of patients under 25 years of age. Eur Spine J 28:2470–2477. https://doi.org/10.1007/s00586-019-06148-1

    Article  PubMed  Google Scholar 

  24. Cai T, Yang L, Cai W, Guo S, Yu P, Li J, Hu X, Yan M, Shao Q, Jin Y, Sun ZS, Luo ZJ (2015) Dysplastic spondylolysis is caused by mutations in the diastrophic dysplasia sulfate transporter gene. Proc Natl Acad Sci U S A 112:8064–8069. https://doi.org/10.1073/pnas.1502454112

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Tins BJ, Balain B (2016) Incidence of numerical variants and transitional lumbosacral vertebrae on whole-spine MRI. Insights Imaging 7:199–203. https://doi.org/10.1007/s13244-016-0468-7

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors acknowledge ThinkSCIENCE, Inc. (Tokyo, Japan) for English language editing.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Contributions

MM and KS acquired, analyzed, and interpreted the data, and drafted the manuscript. KH, HM, FT, and ST analyzed and interpreted the data. KW and KY acquired the data and critically revised the manuscript. KS conceptualized and designed the study; acquired, analyzed, and interpreted the data; and drafted the manuscript.

Corresponding author

Correspondence to Masatoshi Morimoto.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This research was approved by Tokushima University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Written informed consent was obtained from all patients included in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Morimoto, M., Sugiura, K., Higashino, K. et al. Association of spinal anomalies with spondylolysis and spina bifida occulta. Eur Spine J 31, 858–864 (2022). https://doi.org/10.1007/s00586-022-07139-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07139-5

Keywords

  • Spinal anomaly
  • Transitional vertebra
  • Spondylolysis
  • Spina bifida occulta