SACRALISATION OF LUMBAR VERTEBRAE

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Int J Anat Res 2014, 2(2):386-89. ISSN 2321-4287 386

Case Report

SACRALISATION OF LUM BAR VERTEBRAE

Sangeeta W azir.

ABSTRACT

Address for Correspondence: Dr. Sangeeta Wazir, Senior Demonst rat or, Depart ment of Anat omy, Acharya Shri Chander College of M edical Sciences & Research, Jammu. India.

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Senior Demonst rat or, Depart ment of Anat omy, Acharya Shri Chander College of M edical Sciences & Research, Jammu, India.

Background: Lum bar backache is a very com m on problem now adays. Sacralisat ion of lum bar vert ebrae is one of t he cause for t hat . Dur ing rout ine ost eology t eaching a sacrum w it h incom plet e attached lum bar 5 vert ebrae is seen.

Observation: Incom plet ely fused L 5 ver t ebrae w it h sacrum is seen. The bodies of t he vert ebrae are f used but t he t ransverse process of left side is com plet ely fused w it h t he ala of sacrum .But on t he right side is incom plet ely fused.

Conclusion: The person is usually asym pt om at ic or m ay present w it h sym pt om s w hich include spinal or radicular pain, disc degenerat ion, L4/ L5 disc prolapse, lum bar scoliosis and lum bar ext radural defect s. In t ransit ional lum bosacral segm entat ion, it w as observed t hat t he lum bosacral int ervert ebral disc is signif icant ly narrow ed. The incidence of disc her niat ion is found t o be higher and can occur even at young ages. There w as also relat i on sh ip est abl ished bet w een t ransit io nal ver t ebr ae and t he d egr ee o f sl ip page in spo nd yl ol yt ic spondylolist hesis. In addit ion, t his anom aly has know n im plicat ions in t he field of disc surgery.

KEYW ORDS:Radicular Pain, Scoliosis, Herniat ion, Spondylolyt ic.

INTRODUCTION

Int ernat ional Journal of Anatomy and Research, Int J Anat Res 2014, Vol 2(2):386-89. ISSN 2321- 4287

Received: 26 April 2014

Peer Review : 26 April 2014 Published (O):31 M ay2014 Accepted: 15 M ay 2014 Published (P):30 June 2014

Internat ional Journal of Anat omy and Research ISSN 2321-4287

w w w.ijmhr.org/ ijar.ht m

In modern life backache is common complaint . Low back pain (LBP) is quite a common ailment affect ing about 80% of t he populat ion in t heir life t ime [1]. One of t he causes is sacralizat ion of lum b ar ver t ebra. Lum bosacral t r ansit i onal vertebrae (LSTV) occur as a result of congenital anomaly in t he segmentat ion of t he lumbosac-ral spine. LSTV includes eit her t he involvement of L5 in sacrum or S1 int o t he lumbar vertebrae. Sacralizat ion means addit ion of sacral element s by t he incorporat ion of Fift h lumbar vertebra. The incorporat ion of t he fift h lumbar vertebra w it h t he sacrum may be unilateral or bilateral producing part ial or com plet e sacralisat ion. Com plet e sacralizat ion consist s of com plet e bony union bet w een t he abnormal t ransverse

process and t he sacrum. Incomplete sacraliza-t ion show s a w ell defined joinsacraliza-t line besacraliza-t w een sacraliza-t he process and t he sacrum. Bert olott i 1st_observed t he LSTV and stated t hat t hese abnormal verte-brae may produce low back pain due t o art hrit ic changes w hich occur at t he site of false art icula-t ion[2]. LSTV are common w iicula-t h icula-t he prevelance ranging f r om 1-20% [ 3, 4] . Som e prev ious w orkers have suggested t he role of LSTV in low back pain [5, 6], w hereas ot hers have cont ra-dicted t he role of LSTV [6,7]. This case is been highlighted t o help clinicians t o rule out LSTV/ sacralisat ion w hile diagnosing a case of low back pain.

CASE REPORT

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Sangeet a Wazir. SACRALISATION OF LUM BAR VERTEBRAE: A CASE REPORT.

w it h part ial fusion of Lumbar 5 vertebrae was seen. The case is of sacralisat ion of lum bar vertebrae or LSTV.

OBSERVATIONS

The body of t he sacrum and L5 not fused but t h e t r an sv er se p r o cess on l ef t si d e w as completely fused and on right side not fused.

M easurem ent of vert ical lengt h of Lum bar 5 vertebrae- 5.0cm

M easurement of distance bet w een t ransverse processes of L5 vertebrae- 5.7cm

M easu r em en t o f v er t i cal an d t r an sv er se diameter of intervertebral

foramina-Left- 1.5cm and 0.6cm

Right- 1.5cm and 1.65cm

Fig. 1: Show ing Sacralisat ion of Lum bar Ver t ebrae.

DISCUSSION

To understand t he LSTV or sacralisat ion, w e need t o know t he em bryological origin of lum bar v er t eb rae. It co m m en ces at 3r d w eek o f int rauterine life. All vert ebrae originat e from somites t hat form along t he cranial-caudal axis, on eit her side of t he not ochord, from presomatic mesoderm. These somites different iate furt her int o dermomyot ome (fut ure inner dermis and m u scl e) and scl ero t om e. Each scler ot o m e consist s of loosely packed cells cranially and densely packed cells caudally. Som e densely packed cells move cranially opposite t he center of myot ome w here they form intervertebral disc .The remaining densely packed cells fuse w it h t he loosely arranged cells of immediately caudal sclerot ome t o form mesenchymal cent rum,

body of ver t ebra. The m esenchyam al cells surrounding t he neural t ube form neural arch. Ossificat ion of vertebra begins in 8t h_{w eek & ends} by 25t h_{year. There are t w o primary centers &} f i ve seco n dar y cen t er s p r esen t i n each vertebra[8].Secondary centers are one for t he t ip of spinous process, one for t he t ip each t ransverse process & t w o each for annular epiphyses. The primary cause of LSTV is cranial shift s t hat mean sacralizat ion of t he last lumbar vertebrae & part ial shift s w hich mean unilateral fusion of t he t ransverse processes. Literat ure is unclear about exact origin of LSTV; it is likely a product of both genet ic predisposit ion (Hox gene product concent rat ion) and developm ent al influences.Various st udies have been done t o f ind out t he causes, incidence and clinical feat ures of sacralisat ion of lumbar vert ebrae. Kharinar and Nachale found 6.6% of cases in t hei r st u dy [ 9] . W hi ch Co r rel at e w it h t h e o bser vat i on s do n e b y Ch et Savage(7%, 2005)[10]. M agora and Schwart z found 20.8% sacralizat ion in his st udy[11]; Sacralizat ion was found in 11.1% cases by Kubavat dharat i et al [12].Peter et al reported 6.2% sacralisat ion[13]. Otani et al. stated t hat a lumbosacral transitional vertebra was found more often in pat ient s w it h d isc h er n iat io n (17%) t h an in t h e con t ro l group(11%)[14].

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com pared w it h t he disc found bet w een t he t ransit ional vertebra and t he sacrum [24,25]. Also, nerve root canal stenosis has been found at t he level suprajacent t o t he t ransit ional vertebra [24]. According t o Castellvi et al. t he t ransit ional vertebrae cause abnormal t orque movement s above t hese anomalous vertebrae, a fact t hat could result in disc degenerat ion [26]. Aihara et a l. in an anat om ical st udy of 70 cadavers claimed t hat t he iliolumbar ligament at t he level immediately above t he t ransit ional vertebra is m uch t hinner and w eaker t han in cadavers w it hout a lum bosacral t ransit ional vertebra[25].

LSTV t herefore m ay be one of t he causat ive fact ors for low back pain and t he importance of it s ident ificat ion in pat ient s w it h low back pain cannot be ignored. Complicat ions of sacralization of 5t h lumbar vertebra causes pain are act ual pressure on nerves or nerve t runks, ligamentous st rain around t he sacralizat ion, compression of soft t issues bet w een bony joint s, by an act ual art hritis if a joint is present, by a bursit is if a bursa is present . Failure t o recognize & t o find LSTV d u r i n g sp i nal su r ger y m ay hav e ser io u s com plicat ions. LSTV is associat ed w it h disc herniat ion, sciat ic pain in som e individuals. During delivery of baby, pelvis fails t o expand in sacralizat ion.

Pain erupt s 1st t ime in young age & frequent ly hist ory given is pain for few years. The improper for m at ion and union of som it es can cause v er t ebr al ab n or m ali t i es, in cl ud i n g b l ock vert ebrae, cleft vert ebra, and unilateral and bi lat eral hem iver t ebr ae[ 27] . Lum bar spine experiences more abuse from normal funct ions t han any ot her part of human skelet on[19,20]. According t o M .U. Eyo et al t o be able t o give support t o and bear t he w eight of t he body, t he int egr it y of all t he ver t ebrae in t he spine, p ar t i cul ar ly i n t h e l o w er back m u st b e maintained[28, 29].

Conflicts of Interests: None

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SACRALISATION OF LUMBAR VERTEBRAE