Abstract：
Lumbosacral transitional vertebrae (LSTV) are congenital anomalies of the L5-S1 segments characterized by either sacralization of the most caudal lumbar vertebra or lumbarization of the most cephalad sacral vertebra. This variation in anatomy exposes patients to additional surgical risks.
In order to shed light on surgical considerations reported for lumbar spine cases involving LSTV as described in the extant literature, we performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We also present a case example in which wrong level surgery was avoided due to anatomical understanding of LSTV.
A 48-year-old female presented with severe back pain after sustaining a fall from ten feet. The patient exhibited full motor function in all extremities but had begun to experience urinary retention. On initial imaging read, the patient was suspected to have an L1 burst fracture. A review of the imaging demonstrated a transitional vertebra. Therefore, based on the last rib corresponding to T12, the fractured level was L2. This case illustrates the risk LSTV carries for wrong site surgery; appropriate levels were then decompressed and instrumented. On systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a three database literature search identified 39 studies describing 885 patients with LSTV and relevant surgical considerations. The primary indications for surgery were for disc herniation (37%), Bertolotti\'s syndrome (35%), and spinal stenosis (25%). This cohort displayed a mean follow-up time of 23 months. Reherniation occurred in 12 patients (5.5%). Medical management through steroid injection was 24, 72% (n = 80) for the sample. Wrong level surgery occurred in 1.4% (n = 12) of patients.
LSTV represents a constellation of changes in anatomy beyond just a sacralized or lumbarized vertebra. These anatomical differences expose the patient to additional surgical risks. This case and review of the literature highlight avoidable complications and in particular wrong level surgery.
In order to shed light on surgical considerations reported for lumbar spine cases involving LSTV as described in the extant literature, we performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We also present a case example in which wrong level surgery was avoided due to anatomical understanding of LSTV.
A 48-year-old female presented with severe back pain after sustaining a fall from ten feet. The patient exhibited full motor function in all extremities but had begun to experience urinary retention. On initial imaging read, the patient was suspected to have an L1 burst fracture. A review of the imaging demonstrated a transitional vertebra. Therefore, based on the last rib corresponding to T12, the fractured level was L2. This case illustrates the risk LSTV carries for wrong site surgery; appropriate levels were then decompressed and instrumented. On systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a three database literature search identified 39 studies describing 885 patients with LSTV and relevant surgical considerations. The primary indications for surgery were for disc herniation (37%), Bertolotti\'s syndrome (35%), and spinal stenosis (25%). This cohort displayed a mean follow-up time of 23 months. Reherniation occurred in 12 patients (5.5%). Medical management through steroid injection was 24, 72% (n = 80) for the sample. Wrong level surgery occurred in 1.4% (n = 12) of patients.
LSTV represents a constellation of changes in anatomy beyond just a sacralized or lumbarized vertebra. These anatomical differences expose the patient to additional surgical risks. This case and review of the literature highlight avoidable complications and in particular wrong level surgery.
摘要：
背景：腰骶移行椎骨（LSTV）是L5-S1节段的先天性异常，其特征是最尾腰椎的骶化或最头骶椎的腰化。解剖结构的这种变化使患者面临额外的手术风险。
方法：为了阐明现有文献中报道的涉及LSTV的腰椎病例的手术考虑因素，我们根据系统评价和荟萃分析指南的首选报告项目进行了系统评价.我们还提供了一个案例示例，由于对LSTV的解剖学理解，避免了错误的水平手术。
结果：一名48岁的女性在从10英尺处跌倒后出现严重的背痛。患者在所有四肢均表现出完全的运动功能，但开始出现尿潴留。在初始成像读取时，该患者被怀疑患有L1爆裂骨折.影像学检查显示为过渡椎骨。因此,根据T12对应的最后一个肋骨，断裂水平为L2。此案例说明了LSTV进行错误部位手术的风险；然后对适当的水平进行减压并进行仪器检测。根据系统评价和荟萃分析指南的首选报告项目对文献进行系统评价，一项3个数据库的文献检索确定了39项研究,描述了885例LSTV患者和相关的手术考虑.手术的主要适应症是椎间盘突出症（37％），Bertolotti综合征（35%），和椎管狭窄（25%）。该队列显示平均随访时间为23个月。12例（5.5％）发生了再疝。通过类固醇注射的医疗管理为24，72％（n=80）。错误水平手术发生在1.4％（n=12）的患者中。
结论：LSTV代表了一系列解剖结构的变化，而不仅仅是一个圣化或腰椎化的椎骨。这些解剖学差异使患者面临额外的手术风险。此案例和文献综述强调了可避免的并发症，尤其是错误水平的手术。
方法：为了阐明现有文献中报道的涉及LSTV的腰椎病例的手术考虑因素，我们根据系统评价和荟萃分析指南的首选报告项目进行了系统评价.我们还提供了一个案例示例，由于对LSTV的解剖学理解，避免了错误的水平手术。
结果：一名48岁的女性在从10英尺处跌倒后出现严重的背痛。患者在所有四肢均表现出完全的运动功能，但开始出现尿潴留。在初始成像读取时，该患者被怀疑患有L1爆裂骨折.影像学检查显示为过渡椎骨。因此,根据T12对应的最后一个肋骨，断裂水平为L2。此案例说明了LSTV进行错误部位手术的风险；然后对适当的水平进行减压并进行仪器检测。根据系统评价和荟萃分析指南的首选报告项目对文献进行系统评价，一项3个数据库的文献检索确定了39项研究,描述了885例LSTV患者和相关的手术考虑.手术的主要适应症是椎间盘突出症（37％），Bertolotti综合征（35%），和椎管狭窄（25%）。该队列显示平均随访时间为23个月。12例（5.5％）发生了再疝。通过类固醇注射的医疗管理为24，72％（n=80）。错误水平手术发生在1.4％（n=12）的患者中。
结论：LSTV代表了一系列解剖结构的变化，而不仅仅是一个圣化或腰椎化的椎骨。这些解剖学差异使患者面临额外的手术风险。此案例和文献综述强调了可避免的并发症，尤其是错误水平的手术。
