This document discusses lumbosacral transitional vertebrae (LSTV), which are congenital anomalies where the morphology of the last lumbar or first sacral vertebrae are altered. It presents the Castellvi classification system for LSTV and findings from several studies on the prevalence of LSTV and its relationship to low back pain. Studies have found LSTV prevalence rates ranging from 4-30% in populations. LSTV types II and IV, where the abnormal vertebrae is pseudoarticulated to the sacrum, are associated with increased back and buttock pain as well as lower physical activity levels compared to other LSTV types or normal vertebrae.

1. Vertebra de transição Lombo-sacra
R1 Gustavo Andreis
Hospital da Cidade
Radiologia e Diagnóstico por Imagem

2. Introdução
• VT são as anomalias congênitas mais comuns da coluna.
• Prevalência de 4%-30%
(Tokgoz et al., 2014)
– Sacralização da última lombar
– Lombarização da primeira sacral
(Konin et al., 2010)
Primeira descrição de VT associado a lombalgia - Atrose
(Bertolotti M., 1917)

3. Lumbarização Sacralização
Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and
Clinical Relevance
Konin G.P., Walz D.M.
AJNR Am J Neuroradiol 2010

4. Lumbosacral transitional vertebrae and their relationship with lumbar
extradural defects
Castelvi AE, Goldstein LA, Chan DP
Spine 1984
Tipo I: Processo transverso displásico (19mm CC)
Ia: Unilateral
Ib: Bilateral
Tipo II: Lumbarização/Sacralização incompleta
IIa: Unilateral
IIb: Bilateral
Tipo III: Lumbarização/Sacralização completa
IIIa: Unilateral
IIIb: Bilateral
Tipo IV: Tipo II + Tipo III
+ Relação entre VT e o nível inferior.
- Numeração

13. Variations in morphology of the lumbosacral junction on sagittal MRI:
correlation with plain radiography.
O’Driscoll CM
AJNR Am J Neuroradiol 2010

14. • Numeração
–Radiografia panorâmica;
–Ultima costela
•Processo costóide vs costela flutuante
–Ligamentos iliolombares
Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and
Clinical Relevance
Konin G.P., Walz D.M.
AJNR Am J Neuroradiol 2010

15. AJNR Am J Neuroradiol 2010

16. • Numeração
–Radiografia panorâmica;
–Ultima costela
•Processo costóide vs costela flutuante
–Ligamentos iliolombares
AJNR Am J Neuroradiol 2010
Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and
Clinical Relevance
Konin G.P., Walz D.M.

17. • Numeração
–Radiografia panorâmica;
–Ultima costela
•Processo costóide vs costela flutuante
–Ligamentos iliolombares
Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and
Clinical Relevance
Konin G.P., Walz D.M.
AJNR Am J Neuroradiol 2010

18. • Processo transverso de L5 – Crista ilíaca posteromedial.
• Restringe flexão, extensão, rotação axial e flexão lateral de L5-S1.
AJR:187, July 2006
Numbering of Lumbosacral Transitional Vertebrae on MRI: Role of the Iliolumbar Ligaments
Richard J. Hughes, Asif Saifuddin

19. AJR:187, July 2006
Numbering of Lumbosacral Transitional Vertebrae on MRI: Role of the Iliolumbar Ligaments
Richard J. Hughes, Asif Saifuddin
• n: 500
–67 (13,4%) VT
• Ligamento identificado em todos pacientes com junção normal
• Identificado em 21 pacientes com VT

20. Differentiation between Symptomatic and Asymptomatic Extraforaminal Stenosis in Lumbosacral
Transitional Vertebra: Role of Three-Dimensional Magnetic Resonance Lumbosacral Radiculography
Woo Mok Byun et al.,
Korean J Radiol 2012;13(4):403-411

21. Differentiation between Symptomatic and Asymptomatic Extraforaminal Stenosis in Lumbosacral
Transitional Vertebra: Role of Three-Dimensional Magnetic Resonance Lumbosacral Radiculography
Woo Mok Byun et al.,
Korean J Radiol 2012;13(4):403-411

22. Lumbosacral Transition Vertebra: Prevalence and Its Significance
Vijay Sekharappa et al.,
• n: 3000
–A: Urológicos
–B: Ambulatório coluna
–C: Discectomia
Asian Spine J 2014;8(1):51-58

23. Lumbosacral Transition Vertebra: Prevalence and Its Significance
Vijay Sekharappa et al.,
Asian Spine J 2014;8(1):51-58

24. lumbosacral Transitional Vertebrae:Association with Low Back Pain
Lorenzo Nardo et al.,
• n: 4796
• Radiografias
Radiology: Volume 265: Number 2—November 2012

25. lumbosacral Transitional Vertebrae:Association with Low Back Pain
Lorenzo Nardo et al.,
Radiology: Volume 265: Number 2—November 2012

26. lumbosacral Transitional Vertebrae:Association with Low Back Pain
Lorenzo Nardo et al.,
Radiology: Volume 265: Number 2—November 2012

27. lumbosacral Transitional Vertebrae:Association with Low Back Pain
Lorenzo Nardo et al.,
Radiology: Volume 265: Number 2—November 2012

28. lumbosacral Transitional Vertebrae:Association with Low Back Pain
Lorenzo Nardo et al.,
Radiology: Volume 265: Number 2—November 2012
Conclusão
• According to Castellvi classification, patients with LSTV that was
pseudoarticulated to the sacrum (such as types II and IV) were prone to back
and buttock pain (P ,.001 and P 5.001 for types II and IV, respectively).
• Low back pain is more severe in patients with LSTV types II and IV (P ,.001)
and is associated with lower physical activity levels (P ,.001 and P 5.001 for
types II and IV, respectively).
• LSTV types II and IV are associated with back pain, which may affect patient
care.

29. Vertebra de transição Lombo-sacra
R1 Gustavo Andreis
Hospital da Cidade
Radiologia e Diagnóstico por Imagem