What is a Transitional Lumbar Vertebral Body?

[jpman295]

This question was already posted but I had an additional question. Would surgery be recommended with shooting pain down my leg? This is the report I got with the x-rays.


LUMBAR SPINE:

FINDINGS: AP, oblique, and lateral views of the lumbar spine were obtained
without comparison.

There is trace levoconvex curvature through the lumbar region, possibly
positional vs. structural in nature. A transitional vertebral body is seen
at the thoracolumbar junction, with small rudimentary ribs noted, right
greater than left. This will be considered T12 for the purposes of vertebral
body numbering on this exam. A transitional element is also seen at the
lumbosacral junction, with right-sided sacralization and associated
pseudoarticulation with the right sacral ala. Minimal sclerosis is seen at
this site, likely very early degenerative change. No vertebral body height
loss, spondylolysis, or spondylolisthesis is identified. There is no
significant hypertrophic change seen in the lumbar region. Disc spaces
appear relatively well maintained. Slight relative reduction in disc height
at the lumbosacral junction could relate to a small disc given the
transitional vertebral body element. No other focal bone lesions are seen
and paraspinal soft tissue are grossly unremarkable.

IMPRESSION:
1. Transitional vertebral bodies at the thoracolumbar and lumbosacral
junctions, as described above, with right-sided sacralization at L5 showing
pseudoarticulation with the right sacral ala and trace early degenerative
change at this site.
2. Slight relative reduction in disc height at L5-S1 may represent variant
of anatomy given the transitional segment, though early disc disease cannot
be excluded.
3. Slight levoconvex lumbar spinal curvature, positional vs. structural in
nature.


This discussion is related to What is a Transitional Lumbar Vertebral Body??.

[drpearso]

lefty - I already sent you a note regarding your situation, but saw some more comments from you. Your Dr is exactly correct regarding a fusion would make your situation worse. I also saw the x-ray image of the left transverse process from the transitional L6-S1vertabrae. I have the same type situation where the transverse process hits the sacrum and also hits the illium forming a pseudo joint at those 2 locations. My fusion in 1982 made the problem way way worse .... the fusion of the L6-S1 lumbo segment is solid with the sacrum, but the transverse process made a false joint with the ilium also, and since the L6-S-1 segment is solidly fused to the sacrum it allows more movement between the transverse process and the ilium now post fusion surgeries.

Just very interested in how your situation turned out. Mine has been a complete train wreck of a life, and early retirement, and pain medications etc. I assume as you do that he removal of the excess bone that forms the false joint between the ilium and also the sacrum would help.

I have not had the done, instead after 3 lumbar fusions, my new Dr in 1991 attempted a SI fusion to stop the movement between the transverse process and the ilium -- the fusion failed.

Please let me know how  you are doing. Regards, dr

[Lefty67]

Well, injection number one was an immense success. Had three almost completely pain free weeks. The injection is starting to wear off. Called my doc's office last week to request some muscle relaxers. Doc called me back himself to find out how the injection worked. Because we had such success, we are doing a second one just to verify the results and then we will talk to a surgeon about having that excess bone removed from that vertebra.

[Lefty67]

Holy cow! The lumbar transitional is almost exactly like my x-rays! It took me over 4 years to find a doctor that is taking that anomaly seriously. I am scheduled for a diagnostic injection to that area in about a week. From our discussions regarding this, I don't know if surgery would be a good option. My doc told me that the procedure in which they remove the excess bone and make it like the other side has had so-so results and fusing it would actually make things worse.

Over 4 years I have learned what sets things off and how to adjust my activities to minimize flare ups. Basically, no squatting, kneeling, bending or similar things for periods of more than a few seconds. I am definitely much less active than I use to be since my initial flare up at the end of 2005. It has taken me awhile to adapt to that, but I am learning to live with it and keep the pain levels down by altering or limiting what I do.