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Lumbar Sacralization on CT and its Association with Lumbar Fractures in Motor Vehicle Accident Patients 2014

Category General Spine Sohaib Amer. Mohiuddin Imran Qureishi Hamza Alizail Richard Berger Saad Iqbal Purpose The purpose of our study was to determine the clinical significance of the isolated finding of sacralization of the lumbar spine in the setting of trauma patients involved in motor vehicle accidents. Materials & Methods The radiology information system was queried for CT's that included the lumbar spine and ordered at our level 1 trauma center with the indication of "motor vehicle accident". The official dictation of these studies were manually analyzed for mention of sacralization and lumbar fractures. For the patients who had sacralization as an isolated finding, the electronic chart was reviewed to determine the clinical outcome, specifically whether these patients were observed, had short-interval follow-up imaging, or underwent subsequent surgery. Results We propose that in the trauma setting when the isolated finding of sacralization exists, there is an associated risk factor that results in poorer clinical outcome for these patients, including a higher association of sacralization associated with lumbar fractures then in the non-sacralized trauma patients that were in similar motor vehicle accidents. Although this association was not shown in every case, our suggestion is that the etiology maybe related to the transitional vertebrae in sacralization likely affecting the normal biomechanics of the lumbar spine. The lack of mobility at a fused transitional level or the decreased mobility at a partially fused or anomalously articulating vertebra could be the likely etiology. Conclusion We have observed the phenomenon of an isolated finding of sacralization on CT as a risk factor for increased association of lumbar fractures in the setting of trauma patients involved in motor vehicle accidents. We postulated that the sacralized spine has an altered biomechanics that could play a role in our findings. Although the literature has shown in the past that sacralized patients likely have abnormal stress on L4-L5 resulting in accelerated degenerative changes at L4-L5, to the best of our knowledge there is no collection of cases showing the association of sacralization with lumbar fractures in the trauma setting of motor vehicle accidents. References Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. G.P. Konina and D.M. Walza. AJNR Am J Neuroradiol. 2010 Nov;31(10):1778-86. doi: 10.3174/ajnr.A2036. Epub 2010 Mar 4. Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Luoma K, Vehmas T, Raininko R, Luukkonen R, Riihimäki H. Spine (Phila Pa 1976). 2004 Jan 15;29(2):200-5. Lumbosacral transitional vertebrae: association with low back pain. Nardo L, Alizai H, Virayavanich W, Liu F, Hernandez A, Lynch JA, Nevitt MC, McCulloch CE, Lane NE, Link TM. Radiology. 2012 Nov;265(2):497-503. doi: 10.1148/radiol.12112747. Epub 2012 Sep 5.