Far-out Stenosis by the Lumbosacral Transitional Vertebrae

Young Hoon Kim; Ki Sik Yoon

doi:10.4055/jkoa.2011.46.5.438

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Kim and Yoon: Far-out Stenosis by the Lumbosacral Transitional Vertebrae

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(5): 438-442.

Published online: 31 October 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.5.438

Far-out Stenosis by the Lumbosacral Transitional Vertebrae

Young Hoon Kim, M.D., Ki Sik Yoon, M.D.

Department of Orthopedic Surgery, Seoul St.Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Correspondence to: Young Hoon Kim, M.D. Department of Orthopedic Surgery, Seoul St. Mary's Hospital, 505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea. TEL: +82-2-2258-6118, FAX: +82-2-535-9834, boscoa@empal.com

Received 16 November 2010 Accepted 27 April 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Surgeons still have many different views on the clinical significances of the lumbosacral transitional vertebrae as one of the causes of chronic low back pain and a higher incidence of adjacent disc degeneration. Moreover, in rare case reports, compression of the exiting nerve root due to abnormal articulation between the hypertrophied transverse process and the sacral ala has been proposed as one of the reasons for the far-out lumbosacral stenosis. Anterior or posterior surgical decompression is recommended in the cases that are refractory to conservative treatment. We reviewed the related literatures and report on a case that suffered from the far-out stenosis due to lumbosacral transitional vertebra and this was successfully treated by decompression using the posterolateral approach.

Keywords: transitional vertebra, far-out stenosis, posterolateral decompression

Figures and Tables

Figure 1

Plain radiographs show the right abnormal articulation of the enlarged transverse process of the lowest lumbar spine with the sacral alar portion (arrow). It can be classified as a type IIa of the Castellvi's classification.

Figure 2

Preoperative radiographs. (A, B) MR images show no definite compression of the nerve root at central and foraminal portions. (B, C) Right lumbosacral tunnel is encroached by the hypertrophied abnormal transverse process (arrow).

Figure 3

Intraoperative microscopic image shows decompressed nerve root (arrow head) and exposure of anteromedial side of right transverse process (arrow). Postoperative CT shows the decompressed portion of right lumbosacral tunnel (arrow).

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