{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:31:03Z","timestamp":1792225863959,"version":"4.4.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The presence of a thoracolumbar transitional vertebra (TLTV) and\/or lumbosacral transitional vertebra (LSTV) may cause wrong-site surgery and problems while measuring spinopelvic parameters, including pelvic incidence and lumbar lordosis. The Castellvi classification of LSTV addresses coronal images but not sagittal or axial images. Therefore, it is unclear how LSTV differs from the normal lumbosacral anatomy. We aimed to investigate the lumbosacral anatomy and vertebral numbering in patients with TLTV and\/or LSTV. We performed computed tomography (CT) to identify TLTV, to number presacral vertebrae accurately, and to analyze morphological differences in each LSTV type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The medical records of 880 patients who underwent spinopelvic fixation between July 2014 and March 2020 were evaluated for TLTV and LSTV. Castellvi LSTVs (above the promontory on the arcuate line of the ilium) and our newly proposed LSTV (\u201cS6 LSTV,\u201d with 6 sacral vertebrae and 5 foramina below the promontory) were analyzed. The anatomical location of the lowest thoracic vertebra was defined, and TLTV with dysplastic ribs was identified. Each LSTV type was examined for its morphological features on sagittal and axial CT images.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>LSTV was observed in 111 (12.6%) of 880 patients. Castellvi type-III LSTV was the most common (42 [37.8%] of 111), followed by S6 LSTV (37 [33.3%] of 111). TLTV was associated with LSTV (87 [78.4%] of 111) and was commonly identified at T13 (59 [67.8%] of 87). On sagittal CT images, the lumbosacral transitional anatomy of Castellvi LSTVs resembled that of normal L5-S1, and the lumbosacral transitional anatomy of S6 LSTV resembled that of normal S1-S2. When comparing the S1 upper segments on axial CT images, most Castellvi LSTVs exhibited S2-like appearances and most S6 LSTVs exhibited L5-like appearances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Although LSTV possesses L5 and S1 features, Castellvi LSTVs have more L5 elements than S1 elements. The converse is true for S6 LSTV. At least for the Castellvi type-IIIb LSTV, the vertebra below the Castellvi type-IIIb LSTV should be recognized as S1, but clinically it is better to recognize it as S2. Overlooking TLTV may cause problems in vertebral numbering due to coexisting LSTV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Three-dimensional CT images are suitable for detecting transitional vertebrae. This study reveals their morphological features on axial CT images and their lumbosacral anatomy on sagittal CT images.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.20.00167","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T14:39:33Z","timestamp":1626273573000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":20,"title":["Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and\/or Lumbosacral Transitional Vertebrae"],"prefix":"10.2106","volume":"6","author":[{"given":"Yasunori","family":"Tatara","sequence":"first","affiliation":[{"name":"Spine Center, Yokohama Minami Kyosai Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Niimura","sequence":"additional","affiliation":[{"name":"Spine Center, Yokohama Minami Kyosai Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuhiro","family":"Sekiya","sequence":"additional","affiliation":[{"name":"Spine Center, Yokohama Minami Kyosai Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisanori","family":"Mihara","sequence":"additional","affiliation":[{"name":"Spine Center, Yokohama Minami Kyosai Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,7]]},"reference":[{"issue":"1","key":"R1-20240801","doi-asserted-by":"crossref","first-page":"107","DOI":"10.36076\/ppj.2004\/7\/107","article-title":"Segmental anomaly leading to wrong level disc surgery in cauda equina syndrome","volume":"7","author":"Malanga","year":"2004","journal-title":"Pain Physician"},{"issue":"2","key":"R2-20240801","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/BRS.0b013e31816043d1","article-title":"The prevalence of wrong level surgery among spine surgeons","volume":"33","author":"Mody","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"issue":"10","key":"R3-20240801","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.3174\/ajnr.A2036","article-title":"Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance","volume":"31","author":"Konin","year":"2010","journal-title":"AJNR Am J Neuroradiol"},{"issue":"5","key":"R4-20240801","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.surneu.2006.05.069","article-title":"A prospective evaluation of the role for intraoperative x-ray in lumbar discectomy. 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