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Royal National Orthopaedic Hospital, London, England

 
WEB—This is a Web exclusive article

We thank Dr. Bressler for his interest in our article [1] and correspondence. We agree that in the case he presents it can be seen that the patient has abnormal vertebral segmentation with only four true lumbar levels. Because a cervicothoracic localizer was available in his case, in addition to radiographs, numbering can be confidently assigned using a top-down approach.

Our study was focused on the common clinical situation for the radiologist of reporting lumbosacral MRI in isolation without access to radiographs or cervicothoracic localizers. There is no reliable system described to assign levels in this situation [2-6]. Our contention is that in patients with normal lumbosacral segmentation, the anatomic literature suggests that the iliolumbar ligament arises at L5. We therefore propose that the presence or absence of the iliolumbar ligament is a useful system to assign levels when reporting isolated lumbosacral MRI. In our institution, we qualify the report with a statement regarding how the levels were assigned such as, "There is a lumbosacral transitional vertebrae. The transitional level has been designated as L5 for the purposes of this report because the iliolumbar ligament is not visualized at the level above. Radiographic correlation will be necessary if surgical intervention is considered."

We recognize that complex segmentation anomalies may occur (with thoracolumbar transitions, for example) that will complicate level assignment but propose that the system we describe is useful and reproducible for the reporting radiologist without access to radiographs or localizers. Surgical or percutaneous intervention should obviously not be contemplated without radiographic correlation.

References

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1. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments (Web exclusive). AJR 2006; 187:W59 -W66[Abstract/Free Full Text]
2. Hahn PY, Strobel JJ, Hahn FJ. Verification of lumbosacral segments on MR images: identification of transitional vertebrae. Radiology 1992;182 : 580-581[Abstract/Free Full Text]
3. Peh WCG, Siu TH, Chan JHM. Determining the lumbar vertebral segments on magnetic resonance imaging. Spine1998; 17:1852 -1855[CrossRef]
4. Ralston MD, Dykes TA, Applebaum BI. Verification of lumbar vertebra levels (letter). Radiology 1992;185 : 615-616[Free Full Text]
5. Hahn PY, Strobel JJ, Hahn FJ. Verification of lumbar vertebra levels (letter). Radiology 1992;185 : 616[Free Full Text]
6. Lee CH, Seo BK, Choi YC, et al. Using MRI to evaluate anatomic significance of aortic bifurcation, right renal artery, and conus medullaris when locating lumbar vertebral segments. AJR2004; 182:1295 -1300[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Saifuddin, A. Articles by Hughes, R. J. Search for Related Content PubMed Articles by Saifuddin, A. Articles by Hughes, R. J. Social Bookmarking                      What's this?