Domenico Albano, Carmelo Messina, Angelo Gambino, Martina Gurgitano, Carmelo Sciabica, Giordano Remo Oliveira Pavan, Salvatore Gitto, Luca Maria Sconfienza


October 2020, Volume 29, Issue 10, pp 2470 - 2476 Original Article Read Full Article 10.1007/s00586-020-06565-7

First Online: 11 August 2020

Segmented lordotic angles to assess lumbosacral transitional vertebra on EOS

Purpose

To test the vertical posterior vertebral angles (VPVA) of the most caudal lumbar segments measured on EOS to identify and classify the lumbosacral transitional vertebra (LSTV).

Methods

We reviewed the EOS examinations of 906 patients to measure the VPVA at the most caudal lumbar segment (cVPVA) and at the immediately proximal segment (pVPVA), with dVPVA being the result of their difference. Mann–Whitney, Chi-square, and ROC curve statistics were used.

Results

172/906 patients (19%) had LSTV (112 females, mean age: 43 ± 21 years), and 89/172 had type I LSTV (52%), 42/172 type II (24%), 33/172 type III (19%), and 8/172 type IV (5%). The cVPVA and dVPVA in non-articulated patients were significantly higher than those of patients with LSTV, patients with only accessory articulations, and patients with only bony fusion (all p < .001). The cVPVA and dVPVA in L5 sacralization were significantly higher than in S1 lumbarization (p < .001). The following optimal cutoff was found: cVPVA of 28.2° (AUC = 0.797) and dVPVA of 11.1° (AUC = 0.782) to identify LSTV; cVPVA of 28.2° (AUC = 0.665) and dVPVA of 8° (AUC = 0.718) to identify type II LSTV; cVPVA of 25.5° (AUC = 0.797) and dVPVA of − 7.5° (AUC = 0.831) to identify type III–IV LSTV; cVPVA of 20.4° (AUC = 0.693) and dVPVA of − 1.8° (AUC = 0.665) to differentiate type II from III–IV LSTV; cVPVA of 17.9° (AUC = 0.741) and dVPVA of − 4.5° (AUC = 0.774) to differentiate L5 sacralization from S1 lumbarization.

Conclusion

The cVPVA and dVPVA measured on EOS showed good diagnostic performance to identify LSTV, to correctly classify it, and to differentiate L5 sacralization from S1 lumbarization.


Read Full Article