Def
Symptoms
Signs
Lumbosacral transitional vertebrae
Congenital condition
Sacralization of the lowest lumbar vertebral body and
lumbarization of the uppermost sacral segment. These
vertebral bodies demonstrate varying morphology,
ranging from broadened transverse processes to
complete fusion.
Common in general population, reported prevalence of
4%–30%.
Bertolotti Syndrome: low back pain of this syndrome
varying etiologies, from different locations:
1) disk, spinal canal, and posterior element pathology at
the level above a transition
2) degeneration of the anomalous articulation between
an LSTV and the sacrum;
3) facet joint arthrosis contralateral to a unilateral fused
or articulating LSTV;
4) extraforaminal stenosis secondary to the presence of
a broadened transverse process
Extraforaminal stenosis leading to nerve root
entrapment and radiculopathy has been reported+risk of
disc prolapse at the level above the LSTV.
Cervical Rib
Congenital over-dvpt, bony or fibrous, of costal process of C7
vertebra, bilateral or unilateral
Any size from a small bony protrusion to complete
supernumerary rib
Subclavian a+lowest trunk of the brachial plexus arch over the
rib
Lack of mobility at the corresponding segment level
Possible hypermobility at the segment above the LSTV
one
If neurological involvement: signs of n root entrapment
and radiculopathy (muscle weakness, pain on mvt,
sensory changes, +ve neural tissue provocation test)
Assessing nerve root symptoms in patients with an LSTV
complicated because associated variation of lumbosacral
myotomes.
When sacralized L5 vertebral body present, the L4 nerve
root usual function of L5 nerve root; similarly when
lumbarized S1, S1 nerve root functions as L5 nerve root
Sensory impairment in forearm and hand, affected area
corresponding to the lowest trunk of the brachial plexus
Possible mm wasting in thenar eminence (median n) or
interosseous+hypothenar eminence (ulnar n)
Signs of Cyanosis in forearm and hand to signs of gangrene of
fingers, radial pulse might be weak or absent
Pain on Csp mvt (esp SB)
Usually symptomless, if symptoms occur >> early adult life
Neurological:
- pain+paraesthesiae in the forearm and hand, most
marked ulnar side
- weakness in the hand, difficulty with fine mvt
Vascular:
- change in color and temperature noticed
- poor tolerance of cold + activity in UEx affected
+ Adon’s, Wright’s, Allen’s, Roos’, military press test
Tests
Medical Tests
Medical
treatments
CT is the best imaging technique for characterization of
LSTV
MRIs tricky because: limited imaging of the
thoracolumbar junction, identification of the lowest ribbearing vertebral body, and differentiation between
thoracic hypoplastic ribs and enlarged lumbar transverse
processes
Ferguson radiographs (AP radiographs angled cranially at
30°) in the past.
conservative nonsurgical management with local
injection of anesthetic and corticosteroids within the
pseudoarticulation or contralateral facet joint
radiofrequency ablation and surgical management with
partial transverse process resection, and/or posterior
spinal fusion
Direct local anesthetic and steroid injection or surgical
resection of the anomalous or contralateral facet joint
produced successful relief of pain and can yield valuable
diagnostic information.
Operative treatment is suggested in select patients
Contraindications Suspected nerve and vascular damages
Condition has to be distinguished from other causes of:
- pain+paraesthesiae in forearm and hand
- m wasting in hand inc neuro disorders + muscular
dystrophy
- periph vascular changes in UEx inc Raynaul’s disease
X Ray (oblique)
If suspected vascular obstruction arteriography required
Mild cases: manual therapy with exx to improve tone of
elevator mm in shoulder
If more severe with neuro+vascu involvement: operation
advisable (scalenus ant divided)
Suspected nerve and vascular damages