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Numbering of Lumbosacral Transitional Vertebrae on MRI: Role of the Iliolumbar Ligaments

Richard J. Hughes1 and Asif Saifuddin1

1 Both authors: Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London, England HA7 4LP.


Figure 1
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  		Fig. 1A —MRI of lumbar spine in 26-year-old woman with lower back pain. Axial T1-weighted spin-echo images through L4 (A) and L5 (B). Iliolumbar ligament (ILL) is identified as double hypointense band (short arrows, B) running between transverse processes of L5 and posterior iliac blade (long arrows, B). No ILL is identified at L4 level. Lines in insets show levels of imaging.

 

Figure 2
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  		Fig. 1B —MRI of lumbar spine in 26-year-old woman with lower back pain. Axial T1-weighted spin-echo images through L4 (A) and L5 (B). Iliolumbar ligament (ILL) is identified as double hypointense band (short arrows, B) running between transverse processes of L5 and posterior iliac blade (long arrows, B). No ILL is identified at L4 level. Lines in insets show levels of imaging.

 

Figure 3
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  		Fig. 2A —MRI of lumbar spine in 32-year-old woman with lumbar pain. Sagittal T2-weighted fast spin-echo image of lumbar spine shows transitional lumbosacral junction. Lumbosacral transitional vertebra (LSTV) (arrow) lies above transitional disk.

 

Figure 4
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  		Fig. 2B —MRI of lumbar spine in 32-year-old woman with lumbar pain. Axial T1-weighted spin-echo images through vertebra above LSTV (B) and vertebra at LSTV (C). Iliolumbar ligament (short arrows, B) is identified at level above LSTV, defining this as L5 vertebra. LSTV is therefore numbered as S1. Long arrows in B indicate iliac blades. Lines in insets show levels of imaging.

 

Figure 5
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  		Fig. 2C —MRI of lumbar spine in 32-year-old woman with lumbar pain. Axial T1-weighted spin-echo images through vertebra above LSTV (B) and vertebra at LSTV (C). Iliolumbar ligament (short arrows, B) is identified at level above LSTV, defining this as L5 vertebra. LSTV is therefore numbered as S1. Long arrows in B indicate iliac blades. Lines in insets show levels of imaging.

 

Figure 6
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  		Fig. 3A —MRI of lumbar spine in 39-year-old man with lumbar pain and sciatica. Sagittal T2-weighted fast spin-echo image of lumbar spine shows transitional lumbosacral junction. Lumbosacral transitional vertebra (LSTV) (arrow) lies above transitional disk. Note right renal artery (arrowhead).

 

Figure 7
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  		Fig. 3B —MRI of lumbar spine in 39-year-old man with lumbar pain and sciatica. Axial T1-weighted spin-echo images through vertebra above LSTV (B) and vertebra at LSTV (C). Iliolumbar ligament is not identified at level above LSTV. LSTV is therefore numbered as L5. Lines in insets show levels of imaging.

 

Figure 8
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  		Fig. 3C —MRI of lumbar spine in 39-year-old man with lumbar pain and sciatica. Axial T1-weighted spin-echo images through vertebra above LSTV (B) and vertebra at LSTV (C). Iliolumbar ligament is not identified at level above LSTV. LSTV is therefore numbered as L5. Lines in insets show levels of imaging.

 

Figure 9
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  		Fig. 4 —MRI of lumbar spine in 68-year-old woman with lumbar pain. Axial T1-weighted spin-echo image through Castellvi type IIa (unilateral pseudarthrosis) transitional vertebra shows enlargement of left transverse process (long arrow), which extends down to sacral ala. Iliolumbar ligament (short arrow) originates from contralateral transverse process, identifying this as L5 transitional vertebra. Line in inset shows level of imaging.

 

Figure 10
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  		Fig. 5A —MRI of lumbar spine in 39-year-old woman with sciatica. Axial T1-weighted fast spin-echo image at level of mid L5 vertebral body shows anterior (solid arrow) and posterior (dashed arrow) bands of iliolumbar ligament (ILL) originating at tip of L5 transverse process and inserting at iliac tuberosity.

 

Figure 11
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  		Fig. 5B —MRI of lumbar spine in 39-year-old woman with sciatica. Schematic illustration shows vertebral body (L5) and ilium (IL) with anterior band (solid arrow) and posterior band (dashed arrow) of ILL.

 

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