Relationship Between Lumbosacral Transitional Vertebrae And Lumbar Disc Herniation With Low Back Pain

Objective:To explore the clinical correlation between lumbosacral transitional vertebra and lumbar disc herniation and low back pain,so as to provide basis for the diagnosis and treatment of low back pain caused by lumbosacral transitional vertebra.Methods:The image data of all cases in this study were directly measured and evaluated on the picture archiving and communication system（PACS）.comprehensively evaluated by two imaging doctors and one orthopedic doctor.All the above doctors are qualified as attending doctors.On the PACS system,the volume reconstruction images and relevant data information of axial,coronal and sagittal images of CT scans of the two groups of patients were obtained by using multi plane reconstruction（MPR）technology.The lumbosacral transitional vertebrae were classified according to castellvi classification method,and the shape of lumbar vertebrae,the position of iliac crest line flat spine,the warping of lumbar transverse process and the longest transverse process,the highest starting point of psoas major muscle Lumbosacral angle can accurately judge the lumbosacral transitional vertebra.The evaluation standard of the degree of low back pain was evaluated according to the scoring method of the Japanese Orthopaedic Association（JOA）.Results:1.Comparing the number and proportion of different types of lumbosacral transitional vertebrae in the two groups,it is concluded that 56 cases of lumbosacral transitional vertebrae were found in 500 lumbar images in the control group,with an incidence of 11.2%.145 cases of lumbosacral transitional vertebrae were found in 500lumbar images in the low back pain group,with an incidence of 29%.Compared with the control group,the incidence of lumbosacral transitional vertebrae in the low back pain group was significantly higher（P<0.05）.Except for type Ib,the proportion of lumbosacral transitional vertebrae in the low back pain group was significantly different from that in the control group（P<0.05）.Among them,the proportion of type I was significantly lower than that of the control group,and other types were significantly higher than that of the control group2.The proportion of lumbar disc herniation in 355cases of non lumbosacral transitional vertebrae and 145 cases of lumbosacral transitional vertebrae in the low back pain group.The incidence of lumbar 5-sacral 1disc was higher than that of lumbar 4-lumbar 5,and the difference was statistically significant（P<0.05）.2.The proportion of each segment of lumbar disc herniation in low back pain non lumbosacral transitional vertebra group and lumbosacral transitional vertebra group.The main cause of low back pain in the two groups was lumbar disc herniation,and the incidence rates were 86.2%and 96.55%respectively.In the non lumbosacral transitional vertebra group,there was no significant difference in the incidence of lumbar disc herniation between L_3-4、L_4-5and L₅S₁（P>0.05）.In lumbosacral transitional vertebra group,the incidence of L₅S₁disc herniation was significantly higher than that of L_3-4 and L_4-5 disc herniation（P<0.05）.There was no significant difference in the incidence of L_3-4 and L_4-5 disc herniation（P>0.05）.In addition,compared with the non lumbosacral transitional vertebra group,there was no significant difference in the incidence of L_3-4 and L_4-5 disc herniation in the lumbosacral transitional vertebra group（P<0.05）,while the incidence of L₅S₁ disc herniation increased significantly（P<0.05）,and the incidence of other manifestations other than disc herniation decreased significantly（P<0.05）.3.Comparing the effects of symmetrical and asymmetric lumbosacral transitional vertebrae on intervertebral disc herniation in the low back pain group,it is concluded that there are 59 cases of symmetrical lumbosacral transitional vertebrae and 86 cases of asymmetric lumbosacral transitional vertebrae in the low back pain group.The degenerative lesions caused by lumbosacral transitional vertebrae in the two groups were mainly lumbar disc herniation,and the incidence rates were 94.92%and 97.67%respectively.In the symmetrical type of lumbosacral transitional vertebra,the incidence of L₅S₁ disc herniation was significantly higher than that of L_3-4 disc herniation（P<0.05）,There was no significant difference in the incidence of lumbar disc herniation compared with L_4-5（P>0.05）.In the asymmetric type of lumbosacral transitional vertebra,the incidence of L₅S₁ disc herniation was significantly higher than that of L_3-4 lumbar disc herniation and L_4-5 lumbar disc herniation（P<0.05）.The comparison between the two groups also found that the L₅S₁ disc herniation rate in the asymmetric group was significantly higher than that in the symmetric group（P<0.05）,The incidence of disc herniation in L_3-4 and L_4-5 group was close to that in symmetrical group（P>0.05）.4.By comparing the degree of low back pain between lumbosacral transitional vertebra and non lumbosacral transitional vertebra in low back pain group,it is concluded that the proportion of patients with mild,moderate and severe pain in non lumbosacral transitional vertebra group is close（P>0.05）,and there is no significant difference,In the lumbosacral transitional vertebra group,the proportion of patients with severe pain was significantly higher than that of patients with mild and moderate pain（P<0.05）.Compared with non lumbosacral transitional vertebra group and lumbosacral transitional vertebra group,it was found that the proportion of patients with severe pain in lumbosacral transitional vertebra group was significantly higher than that in non lumbosacral transitional vertebra group（P<0.05）,The proportion of patients with mild and moderate pain between the two groups was close（P>0.05）,and there was no significant difference.5.By comparing the degree of low back pain between symmetrical and asymmetric patients in the lumbosacral transitional vertebra group of low back pain,it is concluded that in the symmetrical lumbosacral transitional vertebra group of low back pain,the proportion of patients with mild,moderate and severe pain is close（P>0.05）,and there is no significant difference,In the asymmetric group,the proportion of patients with severe pain was significantly higher than that of patients with mild and moderate pain（P<0.05）,Compared with the symmetrical type,the patients with severe pain in the asymmetric type group increased significantly,while the proportion of patients with mild and moderate pain decreased significantly（P<0.05）,Compared with symmetrical type,the proportion of mild,moderate and severe pain caused by asymmetric type was significantly different（P<0.05）.6.By comparing the relationship between the degree of low back pain and lumbar disc herniation in symmetrical and asymmetric patients with low back pain and lumbosacral transitional vertebra group,it is concluded that there is no significant difference in the distribution of lumbar disc herniation in each segment among patients with symmetrical lumbosacral transitional vertebra of low back pain and mild,moderate and severe pain（P>0.05）.At the same time,there was no significant difference in mild,moderate and severe pain caused by L_3-4,L_4-5 and L₅S₁ disc herniation（P>0.05）.There was no significant difference in the distribution of lumbar disc herniation at each segment between mild and moderate pain in the asymmetric lumbosacral transitional vertebra group of low back pain（P>0.05）,In severe pain,the distribution of lumbar disc herniation at each segment was significantly different（P<0.05）,and the severe pain caused by L₅S₁ disc herniation was significantly higher than L_3-4 and L_4-5（P<0.05）.The proportion of severe pain caused by L_3-4 lumbar protrusion was significantly lower than that of mild and moderate pain（P<0.05）,The proportion of severe pain caused by L_4-5 lumbar protrusion was significantly lower than that of mild and moderate pain（P<0.05）,The proportion of severe pain caused by L₅S₁ lumbar protrusion was significantly higher than that of mild and moderate pain（P<0.05）.7.Through the comparison of the relationship between low back pain and the degree of intervertebral disc herniation,it is concluded that the degree of low back pain is related to the degree of intervertebral disc herniation in both non lumbosacral transitional vertebra and lumbosacral transitional vertebra groups.Compared with the degree of lumbar disc herniation with mild pain,the degree of lumbar disc herniation with moderate and severe pain increased significantly（P<0.05）,At the same time,compared with the lumbar disc herniation in the moderate pain group,the degree of lumbar disc herniation in the severe pain group was also significantly increased（P<0.05）.There was no significant difference in the degree of disc herniation causing the same degree of pain between the non lumbosacral transitional vertebra and lumbosacral transitional vertebra groups（P>0.05）.Conclusions:1.Multiple intervertebral disc segment protrusion caused by lumbosacral transitional vertebra is an important cause of low back pain.2.The incidence of disc herniation in symmetric and asymmetric lumbosacral transitional vertebrae is high and close.However,asymmetric lumbosacral transitional vertebrae are more likely to cause L₅S₁ lumbar disc herniation,and L₅S₁ lumbar disc herniation mainly causes severe low back pain.3.The degree of low back pain caused by disc herniation was positively correlated with the degree of disc herniation in both non lumbosacral transitional vertebra and lumbosacral transitional vertebra groups.4.The imaging analysis of lumbosacral transitional vertebra provides a reference basis for clinical prevention,diagnosis,treatment and prognosis of low back pain.