Skip to main content

Advertisement

Log in

The association between variations in the number of thoracic and lumbar vertebrae and rib morphology in adolescent idiopathic scoliosis

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

Preoperative counting of thoracic and lumbar vertebrae is crucial in adolescent idiopathic scoliosis (AIS) due to reported anatomical variations and potential surgical site misidentification. This study investigated characteristics associated with the vertebral number variations AIS, particularly focusing on rib morphology.

Methods

Based on three-dimensional computed tomography, patients were categorized into the non-variant number group, comprising individuals with 12 thoracic and 5 lumbar vertebrae, and the variant number group, comprising individuals with different numbers of vertebrae. Additionally, the most caudal rib morphology was classified as normal, unilateral, or hypoplastic.

Results

A total of 359 patients were included in our study (41 males, 318 females, age: 16.3 ± 3.1 years), with 44 patients (12.3%) assigned to the variant number group. Logistic regression analysis identified unilateral ribs (odds ratio [OR]: 10.50) and lumbosacral transitional vertebrae (LSTV) (OR 6.49) as significant risk factors associated with variations. Further analysis revealed hypoplastic ribs as a significant risk factor associated with LSTV (OR: 4.58). 8

Conclusion

Our study suggests that abnormal rib morphology may be associated with vertebral number variations. Close attention to rib morphology is, therefore, warranted in cases with atypical vertebral numbers. Accordingly, to ensure surgical safety and accuracy, spine surgeons must communicate these variations to the surgical team, standardize nomenclature for describing them, and intraoperatively verify fusion levels with them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Dta availability

The data supporting this study's findings are available from the corresponding author, KS, upon reasonable request.

References

  1. Mody MG, Nourbakhsh A, Stahl DL et al (2008) The prevalence of wrong level surgery among spine surgeons. Spine (Phila Pa). https://doi.org/10.1097/BRS.0b013e31816043d1

    Article  Google Scholar 

  2. Jhawar BS, Mitsis D, Duggal N (2007) Wrong-sided and wrong-level neurosurgery: a national survey. J Neurosurg Spine 7:467–472. https://doi.org/10.3171/SPI-07/11/467

    Article  PubMed  Google Scholar 

  3. Hu Z, Zhang Z, Zhao Z et al (2016) A neglected point in surgical treatment of adolescent idiopathic scoliosis: variations in the number of vertebrae. Medicine (Baltimore) 95:e4682. https://doi.org/10.1097/MD.0000000000004682

    Article  PubMed  Google Scholar 

  4. Ibrahim DA, Myung KS, Skaggs DL (2013) Ten percent of patients with adolescent idiopathic scoliosis have variations in the number of thoracic or lumbar vertebrae. J Bone Joint Surg Am 95:828–833. https://doi.org/10.2106/JBJS.L.00461

    Article  PubMed  Google Scholar 

  5. Garg B, Mehta N, Goyal A et al (2021) Variations in the number of thoracic and lumbar vertebrae in patients with adolescent idiopathic scoliosis: a retrospective, observational study. Int J Spine Surg 15:359–367. https://doi.org/10.14444/8047

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chiu CK, Chin TF, Chung WH et al (2024) Variations in the number of vertebrae, prevalence of lumbosacral transitional vertebra and prevalence of cervical rib among surgical patients with adolescent idiopathic scoliosis: an analysis of 998 radiographs. Spine. https://doi.org/10.1097/BRS.0000000000004711

    Article  PubMed  Google Scholar 

  7. Yusuke S, Toshiaki K, Tsutomu A (2015) Ideal tilt angle for fluoroscopy to assist an S1 nerve root block as analyzed by three-dimensional computed tomography. J Spine Res 6:938–941

    Google Scholar 

  8. Tatara Y, Niimura T, Sekiya T et al (2021) Changes in lumbosacral anatomy and vertebral numbering in patients with thoracolumbar and/or lumbosacral transitional vertebrae. JB JS Open. https://doi.org/10.2106/JBJS.OA.20.00167

    Article  Google Scholar 

  9. Sunami T, Kotani T, Aoki Y et al (2022) Large lumbar lordosis is a risk factor for lumbar spondylolysis in patients with adolescent idiopathic scoliosis. Spine (Phila Pa). https://doi.org/10.1097/BRS.0000000000004192

    Article  Google Scholar 

  10. O’Brien M, Kuklo T, Blanke K, et al. (2008) Radiographic measurement manual.1–10

  11. Castellvi AE, Goldstein LA, Chan DP (1984) Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa). https://doi.org/10.1097/00007632-198407000-00014

    Article  Google Scholar 

  12. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  13. Spencer HT, Gold ME, Hresko MT (2014) Abnormal rib count in scoliosis surgery: impact on the reporting of spinal fusion levels. J Child Orthop 8:497–503. https://doi.org/10.1007/s11832-014-0623-y

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zhou PL, Moon JY, Tishelman JC et al (2018) Interpretation of spinal radiographic parameters in patients with transitional lumbosacral vertebrae. Spine Deform 6:587–592. https://doi.org/10.1016/j.jspd.2018.01.004

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to express deepest gratitude for Ms. Yuri Ichikawa and Ms. Nana Kondo for assisting with the data collection.

Funding

No funding was received for this work.

Author information

Authors and Affiliations

Authors

Contributions

KS: Kotaro Sakashita: Conceptualization, Methodology, Data collection, Formal analysis and investigation, Writing: original draft preparation, Approval of final version of manuscript, Agreement to be accountable for the work. TK: Conceptualization, Methodology, Data collection, Formal analysis and investigation, Writing: review and editing, Approval of final version of manuscript, Agreement to be accountable for the work. TS: Conceptualization, Methodology, Data collection, Formal analysis and investigation, Writing: review and editing, Approval of final version of manuscript, Agreement to be accountable for the work. YI: Conceptualization, Methodology, Data collection, Formal analysis and investigation, Writing: review and editing, Approval of final version of manuscript, Agreement to be accountable for the work. KO: Conceptualization, Methodology, Data collection, Formal analysis and investigation, Writing: review and editing, Approval of final version of manuscript, Agreement to be accountable for the work. TA: Conceptualization, Methodology, Data collection, Formal analysis and investigation, Writing: review and editing, Approval of final version of manuscript, Agreement to be accountable for the work. SM: Conceptualization. Methodology. Writing: review and editing. Supervision. Approval of final version of manuscript. Agreement to be accountable for the work. SO: Conceptualization. Methodology. Writing: review and editing. Supervision. Approval of final version of manuscript. Agreement to be accountable for the work. MK: Conceptualization. Methodology. Writing: review and editing. Supervision. Approval of final version of manuscript. Agreement to be accountable for the work. MY: Conceptualization. Methodology. Writing: review and editing. Supervision. Approval of final version of manuscript. Agreement to be accountable for the work.

Corresponding author

Correspondence to Kotaro Sakashita.

Ethics declarations

Conflict of interest

Approval for this study was obtained from our institutional ethics review board and approved protocols that adhered to the Declaration of Helsinki principles. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Informed consent

We obtained informed consent from all patients for publication. The manuscript submitted does not contain information about medical devices or drugs.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakashita, K., Kotani, T., Sakuma, T. et al. The association between variations in the number of thoracic and lumbar vertebrae and rib morphology in adolescent idiopathic scoliosis. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00887-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s43390-024-00887-y

Keywords

Navigation