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Interpretation of Spinal Radiographic Parameters in Patients With Transitional Lumbosacral Vertebrae

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Abstract

Study Design

Retrospective radiographic review.

Objectives

To understand the effect of variability in sacral endplate selection in transitional lumbosacral vertebrae (TLSV) and its impact on pelvic, regional, and global spinal alignment parameters.

Background

TLSV can have the characteristics of both lumbar and sacral vertebrae. Difficulties in identification of the S1 endplate may come from nomenclature, number of lumbar vertebrae, sacra, and morphology and may influence the interpretation and consistency of spinal alignment parameters.

Methods

Patients with TLSV were identified and radiographic measurements including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), sagittal vertical axis (SVA), T1-pelvic angle (TPA), pelvic incidence-lumbar lordosis (PI-LL) mismatch, thoracic kyphosis (TK), and spinal inclination (T1SPi) were obtained. Radiographic measurements were performed twice with the sacral endplate at the cephalad and caudal options. Paired t tests assessed the difference between different selection groups.

Results

Of 1,869 patients, 70 (3.7%) were found to have TLSV on radiographic imaging. Fifty-eight (82.9%) had lumbarized sacral segments whereas 12 (17.1%) had sacralized lumbar segments. T1-SPi (mean: −1.77°) and TK (mean: 34.86°) did not vary from altering sacral endplate selection. Selection of the caudal TLSV as the sacral endplate resulted in an increase in all pelvic parameters (PI: 66.8° vs. 44.3°, PT: 25.1° vs. 12.7°, and SS: 41.6° vs. 31.6°), regional lumbar parameters (LL: −54.1° vs. 44.0°, PI-LL: 12.7° vs. 0.3°), and global parameters (SVA: 46.1 mm vs. 28.3 mm, TPA: 23.3° vs. 10.8°) as compared to selecting the cephalad TLSV. All mean differences between radiographic parameters were found to be statistically significant (p < .001).

Conclusions

Variation in sacral endplate selection in TLSV significantly affects spinal alignment parameter measurements. A standardized method for measuring TLSV is needed to reduce measurement error and ultimately allow more accurate understanding of alignment targets in patients with TLSV.

Level of Evidence

Level III.

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Authors and Affiliations

  1. Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, New York, NY, 10003, USA

    Peter L. Zhou BA, John Y. Moon BS, Jared C. Tishelman BA, Thomas J. Errico MD, Themistocles S. Protopsaltis MD, Peter G. Passias MD & Aaron J. Buckland MD

Authors
  1. Peter L. Zhou BA
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  2. John Y. Moon BS
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  3. Jared C. Tishelman BA
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  4. Thomas J. Errico MD
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  5. Themistocles S. Protopsaltis MD
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  6. Peter G. Passias MD
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  7. Aaron J. Buckland MD
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Corresponding author

Correspondence to Aaron J. Buckland MD.

Additional information

Author disclosures: PLZ (none), JYM (none), JCT (none), TJE (none), TSP (grants from DePuy Synthes Spine, during the conduct of the study; personal fees from Medicrea International, grants from Zimmer Spine, outside the submitted work), PGP (personal fees from SpineWave, personal fees Zimmer-Biomet, grants from CSRS, outside the submitted work), AJB (none).

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Zhou, P.L., Moon, J.Y., Tishelman, J.C. et al. Interpretation of Spinal Radiographic Parameters in Patients With Transitional Lumbosacral Vertebrae. Spine Deform 6, 587–592 (2018). https://doi.org/10.1016/j.jspd.2018.01.004

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  • DOI: https://doi.org/10.1016/j.jspd.2018.01.004

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