incorrect surgical procedures occur in patients with variant
spines, including LSTV. 10
Our patient’s transitional anatomy was classified as a
Castellvi type IIa after review with a diagnostic radiologist,
with pseudoarticulation of the left L5 transverse process. The
MRI of his lumbar spine revealed posterior annular tears of
the L3-4 and L4-5 intervertebral discs. It is possible that his
transitional anatomy contributed to hypermobility above the
transitional level, and may have contributed to the annular
tears. Consistent with the available literature, his unilateral
LSTV coincides with the disc bulge on the ipsilateral side and
supradjacent to the transitional anatomy.
The definitive pathophysiology of LSTV remains unclear,
and there is no consensus on the exact approach to evaluation
and management for a given patient. Due to the multifactorial
nature of low back pain in the general population, it is important to consider LSTV as a potential source or complicating
factor. The altered biomechanics present in LSTV may render
increased risk for disc herniation and facet mediated pain, and
LSTV has been implicated in nerve root canal stenosis. 9 There
is no reported increase in spinal stenosis or spondylolysis. 8
Further investigation is warranted into interventional procedures, in diagnostic and therapeutic application.
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D Anderson: Nothing to disclose.
E Knight: Nothing to disclose.
A Best: Nothing to disclose.