Research ArticleLumbar Spine

Optimum Vertebral Level of Castellvi Type III or Higher Lumbosacral Transitional Vertebrae When Measuring Spinopelvic Parameters

Yasunori Tatara, Takanori Niimura, Akira Sakaguchi, Hiroki Katayama and Hisanori Mihara
International Journal of Spine Surgery October 2022, 16 (5) 868-874; DOI: https://doi.org/10.14444/8346

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Schematic diagrams of the Castellvi classification of LSTVs. Type I, including unilateral or bilateral dysplastic transverse process(es) >19 mm, was excluded because it is difficult to distinguish it from a non-LSTV. Normally, there are 4 sacral foramina bilaterally. Still, in types III and IV, the transverse process(es) of the lowest lumbar vertebra and the sacrum are fused, giving the appearance of 5 sacral foramina. LSTV, lumbosacral transitional vertebra.

  • Figure 2
    Figure 2

    Both x-rays (A and B) show the same Castellvi type IIIb case. PI and PT are measured in 2 ways, considering lumbosacral transitional vertebra as the lowest lumbar vertebra (A) or S1 (B).PI, pelvic incidence; PT, pelvic tilt.

  • Figure 3
    Figure 3

    Histograms and normal distribution curves of PI and PT in patients with normal sagittal alignment and coronal balance, excluding patients with lumbosacral transitional vertebra. PI, pelvic incidence; PT, pelvic tilt.

  • Figure 4
    Figure 4

    A 75-year-old man with Castellvi type IIIb. The asterisks in images A (a 3-dimensional CT image) and B (a sagittal reconstruction image of CT myelography) represent LSTV. PI and PT are measured with LSTV as the lowest lumbar vertebra (C) or S1 (D). CT, computed tomography; LSTV, lumbosacral transitional vertebra; PI, pelvic incidence; PT, pelvic tilt; SS, sacral slope.

  • Figure 5
    Figure 5

    A 60-year-old man with Castellvi type IIIb. The asterisks in images A (a 3-dimensional CT image) and B (a sagittal reconstruction image of CT) represent LSTV. PI and PT are measured with LSTV as the lowest lumbar vertebra (C) or S1 (D). CT, computed tomography; LSTV, lumbosacral transitional vertebra; PI, pelvic incidence; PT, pelvic tilt; SS, sacral slope.

  • Figure 6
    Figure 6

    A 72-year-old man with Castellvi type IIIa. The asterisks in images A (a 3-dimensional CT image) and B (a sagittal reconstruction image of CT myelography) represent LSTV. PI and PT are measured with LSTV as the lowest lumbar vertebra (C) or S1 (D). CT, computed tomography; LSTV, lumbosacral transitional vertebra; PI, pelvic incidence; PT, pelvic tilt; SS. sacral slope.

Tables

  • Table 1

    Optimum vertebral level of LSTV by LSTV type based on the reference ranges of pelvic incidence and pelvic tilt.

    Optimum Vertebral Level of LSTVType IIIa (n = 9)Type IIIb (n = 44)Type IV (n = 3) n = 56
    LSTV = lowest lumbar vertebra57214 (25.0%)
    LSTV = S1127129 (51.8%)
    LSTV = intermediate310013 (23.2%)

    • Abbreviations: LSTV, lumbosacral transitional vertebra.

  • Table 2

    Measurement of PI and PT with LSTV as LLV or S1.

    Optimum Vertebral Level of LSTVLLV_PILLV_PTS_PIS_PT
    LSTV = LLV (n = 14)50.5 (5.6)18.3 (5.5)31.5 (5.2)8.9 (7.5)
    LSTV = S1 (n = 29)68.1 (7.8)35.4 (4.7)48.3 (7.4)17.7 (5.3)
    LSTV = intermediate (n = 13)61.4 (3.4)24.7 (2.9)42.2 (3.9)11.5 (3.5)

    • Abbreviations: LLV, lowest lumbar vertebra; LSTV, lumbosacral transitional vertebra; PI, pelvic incidence; PT, pelvic tilt.

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Optimum Vertebral Level of Castellvi Type III or Higher Lumbosacral Transitional Vertebrae When Measuring Spinopelvic Parameters
Yasunori Tatara, Takanori Niimura, Akira Sakaguchi, Hiroki Katayama, Hisanori Mihara
International Journal of Spine Surgery Oct 2022, 16 (5) 868-874; DOI: 10.14444/8346
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