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Numbering of Lumbosacral Transitional Vertebrae on MRI

Suburban Radiologic Consultants, Ltd., Minneapolis, MN 55305

 
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After reading the article by Drs. Hughes and Saifuddin [1], I tested their conclusion that the iliolumbar ligament always arises from L5. My fourth case disproves their assertion. As is apparent from the images in Figures 1 and 2A, 2B and my review of thoracolumbar radiographs showing seven cervical vertebrae and 12 ribs, this patient has four lumbar-type vertebrae with the iliolumbar ligaments at L4. The next vertebra is transitional, and it could be described as either a partially sacralized L5 or a partially lumbarized S1 with four lumbar vertebrae.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —76-year-old woman with lower back pain. Sagittal localizing T1-weighted MR image for counting. Note fractures of T11 and T12.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Axial T2-weighted images with inset sagittal scout images, same patient as Figure 1. Sagittal scout image inset shows that iliolumbar ligaments are at L4, not L5 as asserted in the Hughes and Saifuddin article [1].

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Axial T2-weighted images with inset sagittal scout images, same patient as Figure 1. Axial image through transitional vertebra that could be called partially lumbarized S1 in patient with four lumbar vertebrae or a partially sacralized L5. Note absence of iliolumbar ligaments.

The problem with the conclusion of Hughes and Saifuddin is that they assume there are always five lumbar vertebrae—that is, there must always be an L5. This incorrect assumption will lead to incorrect numbering in some cases. For example, in my case, labeling the vertebra with the iliolumbar ligaments L5 and counting from inferior to superior leads to the L1 vertebra having ribs and the fractures being in T12 and L1 when they are really in T11 and T12.

A more accurate conclusion of their research would be that the iliolumbar ligament arises from the last lumbar vertebra, although this could be L4, L5, or L6 depending on the segmentation of the rest of the spine.

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1. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR 2006; [web]187 : W59-W66[Abstract/Free Full Text]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bressler, E. L. Search for Related Content PubMed PubMed Citation Articles by Bressler, E. L. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?