Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis
Objective: Lumbosacral transitional vertebrae (LSTV) are an underdiagnosed source of low back pain (LBP), or Bertolotti Syndrome. This study identifies trends in radiographic lumbo–pelvic parameters among LSTV patients that may serve as prognostic indicators for surgery. Methods: A retrospective cha...
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Elsevier
2025-10-01
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| Series: | World Neurosurgery: X |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139725000663 |
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| author | Nikita Das Ravi Dhamija Orlando Martinez John Francis Rohit Mauria Collin M. Labak Eric Z. Herring Gabriel Smith |
| author_facet | Nikita Das Ravi Dhamija Orlando Martinez John Francis Rohit Mauria Collin M. Labak Eric Z. Herring Gabriel Smith |
| author_sort | Nikita Das |
| collection | DOAJ |
| description | Objective: Lumbosacral transitional vertebrae (LSTV) are an underdiagnosed source of low back pain (LBP), or Bertolotti Syndrome. This study identifies trends in radiographic lumbo–pelvic parameters among LSTV patients that may serve as prognostic indicators for surgery. Methods: A retrospective chart review identified LSTV patients using a free-text search of our institution's electronic medical record for terms related to “LSTV” and ''Bertolotti.'' Patients lacking radiographic evidence of abnormal fusion between L5 and the sacrum/ilium were excluded. Clinical features and spinopelvic parameters, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were analyzed. Results: Of 122 LSTV patients, 108 (88.5 %) had LBP consistent with Bertolotti Syndrome. Median L4-L5 lordosis was 17.9° [16.9°, 18.9°], L5-S1 lordosis was 15.2° [14.2°, 16.2°]. Median PI was 65.7° [63.4°, 67.9°], with a PI-LL mismatch of 8.4° [6.1°, 10.7°]. Median PT was estimated at 25.1° [23.3°, 26.9°]. Significant associations existed between pain severity and PT > 35° (p = 0.004), as well as increased PI (p = 0.03). Castellvi Type II LSTV patients were more likely to have an L5/S1 angle >15° (p = 0.02). Conclusions: This study aims to improve and understand the impact of spinopelvic parameters for patients with LSTV. Elevated Pelvic Tilt and Pelvic Incidence are associated with increased risk of LSTV manifesting as Bertolotti Syndrome. Additionally, the lumbosacral transition may not be located at L5/S1 in these patients. Development of algorithm-based technologies that identify LSTV radiographically and measure corresponding spinopelvic parameters using standardized protocols may facilitate improvements in care for this patient population. |
| format | Article |
| id | doaj-art-b02010d6c1774b459224f7bb6a99da35 |
| institution | Kabale University |
| issn | 2590-1397 |
| language | English |
| publishDate | 2025-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Neurosurgery: X |
| spelling | doaj-art-b02010d6c1774b459224f7bb6a99da352025-08-20T03:51:14ZengElsevierWorld Neurosurgery: X2590-13972025-10-012810049210.1016/j.wnsx.2025.100492Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysisNikita Das0Ravi Dhamija1Orlando Martinez2John Francis3Rohit Mauria4Collin M. Labak5Eric Z. Herring6Gabriel Smith7Case Western Reserve University School of Medicine, Cleveland, OH, USACase Western Reserve University School of Medicine, Cleveland, OH, USACase Western Reserve University School of Medicine, Cleveland, OH, USACase Western Reserve University School of Medicine, Cleveland, OH, USADepartment of Neurological Surgery, University Hospitals, Cleveland, OH, USADepartment of Neurological Surgery, University Hospitals, Cleveland, OH, USADepartment of Neurological Surgery, University Hospitals, Cleveland, OH, USA; Corresponding author. University Hospitals Department of Neurological Surgery, 11100 Euclid Ave, Hanna House 5042, Cleveland, OH, 44106, USA.Department of Neurological Surgery, University Hospitals, Cleveland, OH, USAObjective: Lumbosacral transitional vertebrae (LSTV) are an underdiagnosed source of low back pain (LBP), or Bertolotti Syndrome. This study identifies trends in radiographic lumbo–pelvic parameters among LSTV patients that may serve as prognostic indicators for surgery. Methods: A retrospective chart review identified LSTV patients using a free-text search of our institution's electronic medical record for terms related to “LSTV” and ''Bertolotti.'' Patients lacking radiographic evidence of abnormal fusion between L5 and the sacrum/ilium were excluded. Clinical features and spinopelvic parameters, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were analyzed. Results: Of 122 LSTV patients, 108 (88.5 %) had LBP consistent with Bertolotti Syndrome. Median L4-L5 lordosis was 17.9° [16.9°, 18.9°], L5-S1 lordosis was 15.2° [14.2°, 16.2°]. Median PI was 65.7° [63.4°, 67.9°], with a PI-LL mismatch of 8.4° [6.1°, 10.7°]. Median PT was estimated at 25.1° [23.3°, 26.9°]. Significant associations existed between pain severity and PT > 35° (p = 0.004), as well as increased PI (p = 0.03). Castellvi Type II LSTV patients were more likely to have an L5/S1 angle >15° (p = 0.02). Conclusions: This study aims to improve and understand the impact of spinopelvic parameters for patients with LSTV. Elevated Pelvic Tilt and Pelvic Incidence are associated with increased risk of LSTV manifesting as Bertolotti Syndrome. Additionally, the lumbosacral transition may not be located at L5/S1 in these patients. Development of algorithm-based technologies that identify LSTV radiographically and measure corresponding spinopelvic parameters using standardized protocols may facilitate improvements in care for this patient population.http://www.sciencedirect.com/science/article/pii/S2590139725000663Bertolotti syndromeLumbosacral transitional vertebraeLow back pain |
| spellingShingle | Nikita Das Ravi Dhamija Orlando Martinez John Francis Rohit Mauria Collin M. Labak Eric Z. Herring Gabriel Smith Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis World Neurosurgery: X Bertolotti syndrome Lumbosacral transitional vertebrae Low back pain |
| title | Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis |
| title_full | Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis |
| title_fullStr | Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis |
| title_full_unstemmed | Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis |
| title_short | Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis |
| title_sort | structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae a retrospective cohort analysis |
| topic | Bertolotti syndrome Lumbosacral transitional vertebrae Low back pain |
| url | http://www.sciencedirect.com/science/article/pii/S2590139725000663 |
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