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The Implications of Lumbarized Transitional Vertebra on Spino-pelvic Sagittal Alignment
Marc Khalifé1,2,3, Claudio Vergari4, Renaud Lafage3
1Department of Orthopedic Surgery, Hôpital Européen Georges Pompidou, Paris, France.
Study Design:
Multicentric prospective study.
Objective:
This study aimed to analyze lumbarized transitional vertebra (LTV) impact on spinal alignment, according to Castellvi grade, particularly regarding lumbar lordosis (LL) magnitude and distribution.
Summary Of Background Data:
Few data is available regarding sagittal alignment in patients with LTV.
Methods:
Only healthy volunteers aged above 18 years with full-body biplanar radiograph were included. In case of LTV, the sixth lumbar vertebra was named "L0", between T12 and L1. Pelvic and acetabular parameters, thoracic, cervical and global alignment were analyzed. LL was assessed through maximum, proximal and distal according to thoracolumbar inflection point and apex location as well as with fixed vertebrae: L1-S1, L1-L4 and L4-S1. Castellvi I and II were considered low-grade and Castellvi III and IV as high-grade LTV. Comparisons between the three groups (No, low-grade and high-grade) were performed, before and after matching on pelvic incidence (PI).
Results:
This study included 713 subjects (50.6% F, mean age: 37.5±16.2). 10.1% (n=72) presented transitional vertebra, of which 22 with lumbarization, 13 low-grade and 9 high-grade. PI was greater in LTV subjects. LLmax increased from -59.7±11.0° in No-LSTV subjects to -67.5±19.4° in high-grade LTV, mainly through proximal arc measured both through L1-L4 and LLprox. Lumbar apex was more cranial in LTV subjects: 5.9% in L3 in No-lumbarization cohort versus 53.9% and 44.4% respectively in low-grade and high-grade. A decreased lordosis in the transitional segment was partially compensated for by a steeper increase of LL above L5 in both LTV groups. After matching, LTV subjects presented lesser maximum lordosis than No-LTV subjects, driven by lesser distal lordosis, more anterior global alignment with greater T1PA and greater pelvic retroversion.
Conclusions:
Lumbarization individuals present decreased distal lordosis and a more cranial lumbar apex resulting in a more anteriorly tilted global sagittal alignment. Pelvic and spinal alignment parameters normative values are provided for LTV subjects.
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