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A vertebral shape-based classification for labeling the thoracolumbar junction on CT imaging.

David Schinz1,2, Hendrik Möller3, Constanze Ramschütz3

  • 1Universitätsklinikum Erlangen, Erlangen, Germany. david.schinz@uk-erlangen.de.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|September 26, 2025
PubMed
Summary

A new vertebra-shape-based classification (VSBC) accurately labels the thoracolumbar junction. This method is more consistent and reliable than current rib-based methods, especially for incomplete spine views.

Keywords:
Computed tomographySpineSpine aberrationThoracolumbar junctionThoracolumbar transitional vertebraeVertebra labeling

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Area of Science:

  • Radiology and Imaging
  • Anatomy
  • Medical Diagnostics

Background:

  • Accurate identification of the thoracolumbar junction is crucial for lumbar spine labeling.
  • Current methods like continuous counting-based (CCBC), rib-length-based (RLBC), and rib-based classification (RBC) can yield inconsistent results.
  • Inconsistencies arise due to variations in visualized spinal segments.

Purpose of the Study:

  • To evaluate the reliability and consistency of different thoracolumbar junction identification methods.
  • To compare vertebra-shape-based classification (VSBC) against CCBC, RLBC, and RBC.
  • To assess agreement with nerve morphology and inter-rater reliability.

Main Methods:

  • Retrospective study analyzing CT scans from 1,242 subjects (2005-2018).
  • Evaluated CCBC, RLBC/RBC, and VSBC for thoracolumbar junction assessment.
  • Compared classifications based on label consistency, nerve morphology agreement, and inter-rater reliability.

Main Results:

  • The VSBC demonstrated superior consistency in labeling compared to all other methods.
  • VSBC achieved 100% compliance with nerve morphology, outperforming RBC (97.2%), RLBC (96.3%), and CCBC (92.6%).
  • VSBC showed slightly better inter-rater reliability (0.61) than RBC (0.59).

Conclusions:

  • The VSBC is a more reliable and consistent method for labeling the thoracolumbar junction.
  • VSBC is effective even with anatomical variants or incomplete spinal visualization.
  • VSBC offers clear advantages over rib-based classifications in consistency and nerve morphology agreement.