Lumbosacral transitional segments

Would be interested on thoughts regarding a friend; an individual S/P ALIF of "L5-S1" for discogenic pain and two Dallas IV tears after an MVA of significant impact, which was really a spinal fusion of "S1-S2" with that segment being  a Castelli  Type II LSTV. I thought the discs of LSTV's are usually hypoplastic, and stronger/less susceptible ot trauma and degenerative disc disease? This individual has significant residual "facet" pain controlateral to the congenital pseudarthoses since her fusion, along with a radiculitis not present before surgery, and now evidence of disc herniation and possible adjacent disc disease above her level of fusion. She is contemplating further posterior fixation, which  has  recommended by several individuals, versus ADR.Should resection of the pseudarthroses have been entertained initially?

[S. Kaul, MD]

Hi there!

A transitional vertebra at the lumbosacral junction can cause arthritis, disk changes, or spinal cord compression and an increased risk for developing cauda equine syndrome. It would be inappropriate to comment on what would have been the procedure of choice or the appropriate management without knowing the clinical details and if the degeneration was actually related to the surgery. You may discuss the details with your orthopedician or may seek a second opinion.

Take care!