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Is T9-11 the true thoracolumbar transition zone?

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|September 9, 2020
PubMed
Summary

The thoracolumbar junction, typically considered T12-L1, may actually be higher at T10-11. This study found increased disc degeneration and segmental loads at T9-11, supporting a revised anatomical understanding for spinal health.

Keywords:
Disc degenerationThoracic spinal stenosisThoracolumbar junction

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Area of Science:

  • Orthopedics
  • Spinal Anatomy
  • Radiology

Background:

  • Degenerative thoracic stenosis commonly affects lower thoracic segments (T9-T12) due to spinal mobility.
  • The traditional thoracolumbar junction is defined as T12-L1, marking the transition between the thoracic and lumbar spine.
  • Anecdotal evidence suggests increased mobility and potential degeneration may occur higher, at T10-11.

Purpose of the Study:

  • To investigate the hypothesis that the true thoracolumbar junction is located at T10-11.
  • To evaluate disc degeneration and segmental loads at different thoracolumbar levels.
  • To determine if the transition from floating to false ribs influences spinal biomechanics.

Main Methods:

  • Retrospective review of 322 MRI studies of the spine in patients aged 10-40.
  • Exclusion of patients with prior surgery, chronic spinal disorders, or congenital abnormalities.
  • Assessment of intervertebral disc degeneration using the Pfirrmann grading system and analysis of segmental loads from computer models.

Main Results:

  • Mean Pfirrmann grade for disc degeneration was highest at T8-9 and T9-10.
  • Significant differences in Pfirrmann grade were observed across all thoracic and lumbar levels.
  • Mean load gradient was significantly higher from T9-T11 compared to T11-L1 in both sitting and standing positions.

Conclusions:

  • Increased disc degeneration and segmental loads at T9-11 support the hypothesis of a higher thoracolumbar transition.
  • The findings suggest the true thoracolumbar junction is at T10-11, coinciding with the transition of the rib cage.
  • This revised understanding has implications for diagnosing and treating spinal conditions in this region.