腰骶部移形椎与退行性腰椎管狭窄的临床相关性

Clinical Correlation between Lumbosacral Transitional Vertebrae and Degenerative Lumbar Spinal Stenosis

摘要: 背景：近一个世纪前，文献首次描述了腰椎和骶骨之间关系的解剖学变化，并在退行性腰椎管狭窄(DLSS)、下腰痛(LBP)中继续发挥重要作用。这篇综述将集中于腰骶部移形椎在DLSS的临床和外科意义。方法：使用关键字“腰骶部移形椎”、“LSTV”、“TLSV”、“下腰痛”、“腰椎骶化”和“DLSS”进行PubMed及知网搜索。临床意义：在文献中，LSTV的患病率差异很大，在脊柱文献中从3.9%到35.6%不等，而腰椎管狭窄症是老年人群中最常见的诊断和治疗的疾病之一，在有下肢症状的成人中，其临床患病率约为47%。目前较多文献报道腰骶部移行椎与增加腰骶部椎间盘的退变、变性有关，也可引起或加重腰椎间盘的突出。但现在对腰骶部移形椎与腰椎管狭窄的相关性研究较少。虽然目前还没有一致的病因，但疼痛的来源是多因素的，可能与异常的生物力学和对齐、椎间盘退变和关节炎的改变有关。

Abstract: Background: Anatomic variation in the relationship between the lumbar spine and sacrum was first described in the literature nearly a century ago and continues to play an important role in spine deformity, low back pain (LBP). This review will focus on the clinical and surgical implications of abnormal lumbosacral anatomy in the (DLSS) disease. Methods: A PubMed search using the key-words ‘‘lumbosacral transitional vertebrae’’, ‘‘LSTV’’, ‘‘transitional lumbosacral vertebrae’’, ‘‘TLSV’’, and ‘‘DLSS’’ was performed. Clinical Significance: The prevalence of LSTV varies widely in the litera-ture from 3.9% to 35.6% in the spine literature, and sacral dysmorphism is described in upwards of 47% of the population in the trauma literature. There are few studies on the correlation between the LSTV and DLSS. While there is no agreed-on etiology, the source of pain is multifactorial and may be related to abnormal biomechanics and alignment, disc degeneration, and arthritic changes.