The Association of Lumbosacral Transitional Vertebrae with Low Back Pain and Lumbar Degenerative Findings in MRI - A Large Cohort Study.

STUDY DESIGN A cross-sectional study of the Northern Finland Birth Cohort 1966 (NFBC1966). OBJECTIVE To evaluate the association of lumbosacral transitional vertebrae (LSTV) with low back pain (LBP) and associated degenerative findings using MR imaging. SUMMARY OF BACKGROUND DATA LSTV is a common finding with a prevalence of 10% to 29%. LSTV causes biomechanical alterations leading to accelerated lumbar degeneration. However, its association with degenerative findings on MRI and LBP is unclear. METHODS 1468 lumbar spine MRI scans from the NFBC1966 acquired at a mean age of 47 years were assessed for the presence of LSTV and degenerative changes. Castellvi classification was utilized to identify LSTV anatomy. Additionally, 100 controls without LSTV were collected. Self-reported LBP with a duration of >30 days in the past year was deemed clinically relevant. For the statistical analyses, chi square test, independent samples t-test and multinomial logistic regression analyses were used. RESULTS LSTV was found in 310 (21.1%) subjects. After adjusting for age, sex and disc degeneration (DD) sum, subjects with Castellvi type III reported prolonged LBP significantly more frequently than the controls (OR = 8.9, p = 0.001). We observed a higher prevalence of facet degeneration (FD) at all levels from L3/L4 to L5/S1 in type I, and L3/L4 to L4/L5 in types II-IV. DD was more prevalent at L4/L5 in types II-IV. Disc protrusion/extrusion occurred more frequently at L3/L4 and L4/L5 in type II, and at L3/L4 in type III. Castellvi type II had a higher prevalence of type 1 Modic changes at all levels from L3/L4 to L5/S1, and type IV had a higher prevalence of any Modic changes at L4/L5. CONCLUSION LSTVs were a common finding within this study, and Castellvi type III LSTVs were associated with LBP. Degenerative findings were associated with LSTV anatomy and occurred more commonly above the transitional level.Level of Evidence: 3.