Diagnostic Limitations and Aspects of the Lumbosacral Transitional Vertebrae (LSTV)

The regeneration of an intervertebral disc can only be successful if the cause of the degeneration is known and eliminated. The lumbosacral transitional vertebrae (LSTV) offer itself as a model for IVD (intervertebral disc) regeneration. The aim of this work is to support this statement. In our scoliosis outpatient clinic, 1482 patients were radiologically examined, and ambiguous lumbosacral junction underwent MRI examination. Patients with Castellvi classification type II–IV were included and the results are compared with the current literature in PubMed (12 October 2022). The LSTV are discussed as a possible IVD model. A total of 115 patients were diagnosed with LSTV Castellvi type II–IV. A Castellvi distribution type IIA (n-55), IIB (n-24), IIIA (n-20), IIIB (n-10) and IV (n-6) can be found. In all, 64 patients (55.7%) reported recurrent low-back pain (LBP). Scoliosis (Cobb angle >10°) was also confirmed in 72 patients (58 female and 14 male) and 56 (75.7%) had unilateral pathology. The wide variation in the literature regarding the prevalence of the LSTV (4.6–35.6%) is reasoned by the doubtful diagnosis of Castellvi type I. The LSTV present segments with reduced to absent mobility and at the same time leads to overload of the adjacent segments. This possibility of differentiation is seen as the potential for a spinal model.