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Accuracy of the Criteria for Numbering of Lumbar Vertebrae on Plain Radiograph 2011

General Spine

Ji Young, Hwang, Dr
Sook Yun, Song, Dr, Non ASSR Member
Hyun-hae, Cho, Dr, Non ASSR Member
Misook, Sung, Dr, Non ASSR Member
Su Jin, Kim, Dr, Non ASSR Member

Poster

Purpose

The purpose of this study was to determine whether some criteria based on lumbar spine AP and lateral view are accurate for numbering of lumbar vertebrae.

Methods & Materials

The lumbar spine AP and lateral views of 309 asymptomatic patients were reviewed. Lumbar spine AP views were assessed for the number of lumbar vertebrae which were defined as vertebrae without any fusion to the last rib or first sacral segment. The four criteria for determining lumbar levels were used as follows; (1) vertebra with the longest transverse process on L spine AP was regarded as L3, (2) the level of iliac crest was regarded as between the L4 and L5, (3) horizontally oriented vertebra on L spine lateral view was regarded as L4 vertebra (4) the level with largest sagittal plane angulation was regarded as between the L5 and S1. We calculated the accuracy of each criterion.

Results

Of the 309 patients, 289 (93.5%) had normal lumbosacral segmentation (5 lumbar vertebrae) and 20 had a transitional lumbosacral junction. Sixteen (5.1%) had 4 lumbar vertebra, 4 (1.3%) had 6 lumbar vertebra. Criterion (1) was available in 289 (93.5%) patients, Criteria(2) and (4) were available in all 309 (100%) patients, Criterion (3) was available in 275 (89%) patients. The accuracy of each criterion for determining lumbar levels were 92% by using criterion (1), 97.7% by using criterion (2), 58.5% by using criterion (3), 93.2% by using criterion (4).

Conclusion

We suggest that the position of iliac crest as a marker of the L4-5 level and segment with largest sagittal plane angulation as a marker of the L5-S1 level on lumbar spine AP and lateral view can be used to assign lumbar levels.

References/Financial Disclosures

1. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR 2006;187(1):W59-65N 2. Konin GP, Walz DM. Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR 2010;31(10):1778-86. 3. Bressler EL. Numbering of lumbosacral transitional vertebrae on MRI. AJR 2007;188(2):W210 No Financial Disclosures