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       Thanks Rachel!!! You are a huge help!! Thanks for the reference point on the CRP, I didn't know that 1mg/ml is the normal range. Ya, the SED rate is iffy I know. Probably why the rhuemy didn't get into it. Thanks again!!! Although the right renal artery is usually located at the L1–2 disk space, 25% of the time it is either not imaged or is present at another location. 33. RESULTS: The L5 nerve arose from the 24th presacral vertebra (L5) in 106/108 cases. The percentage of perfect agreement with the reference standard was 98.1% (95% CI, 93.5%–99.8%), which was preserved in transitional and numeric variation states. The iliolumbar ligament localization method showed 83.3% (95% CI, 74.9%–89.8%) perfect agreement with the reference standard. Inter- and intrarater reliability when using the nerve morphology method was strong. In the cases with 13 rib-bearing vertebrae, we considered it "lumbar thoracization" with L1 having supranumery ribs. After T12, the vertebrae were counted as lumbar-type, extending to the level of the lumbosacral junction. Based on morphology and laterality per the Castellvi classification, 23. Results One hundred eight patients were randomly selected from this data base inquiry (60 females). The combined subject group ranged in age from 18–90 years (mean, 51.9 years ± 16.9). The female patients ranged in age from 18–90 (mean, 50.1 years), and the male patients ranged in age from 29–87 (mean, 54.1 years). Bertolotti syndrome, the association between an LSTV and low back pain, is controversial and has been both supported and disputed since Bertolotti first described it in 1917. 2. The information provided by SpinalCord.com is not a substitute for professional medical advice, diagnosis, or treatment, see. Multiple imaging modalities have been used to evaluate LSTV and VNV, with MR imaging found to be most reliable. 18. Lumbarization can be diagnosed through simple tests such as an X-ray of the spine. Both a front view and a side view of the lumbosacral spine are essential to make an accurate diagnosis. However, in obese individuals the spine may not be clearly seen through X-rays and a more intricate scan such as a CT scan may be helpful. MRI scans can help determine whether any nerve involvement has occurred. Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation! MATERIALS AND METHODS: One hundred eight cases with full spine MR imaging were numbered from the C2 vertebral body to the sacrum with note of thoracolumbar and lumbosacral transitional states. The origin level of the L5 nerve and iliolumbar ligament were documented in all cases. The reference standard of numbering by full spine imaging was compared with the nerve morphology numbering method. Five blinded raters evaluated all lumbar MRIs with nerve morphology technique twice. Prevalence and bias-adjusted κ were used to measure interrater and intrarater reliability. Having a sixth lumbar vertebrae in your spine is uncommon, but far from extraordinary. Axial T2-weighted MR images at the level of the sacrum with corresponding graphics demonstrating how the caliber of the nerve roots along the sacrum can be used to identify the number of lumbar vertebral segments. In patients with 4 lumbar segments, the L4 nerve root is seen splitting over the lateral sacrum ( A, arrows ). In patients with 5 lumbar segments, the peroneal branch of L4 joins the L5 nerve root, which is twice the caliber of L4 ( B, arrows ). In patients with more than 5 lumbar segments, 2 nerves of similar caliber will be seen along the lateral sacral wing, representing L5 laterally and S1 medially ( C, arrows ). A person can have VNV without LSTV, or conversely, one can have LSTV without VNV. 1. because it allows better differentiation at the thoracolumbar junction. However, given the large field of view and increased section thickness of these localizers, they still commonly do not provide enough reliable anatomic information to consistently number the segments of the lumbar spine correctly. In addition, many radiologists do not routinely obtain an MR localizer inclusive of the cervical and thoracic spine when imaging patients with low back pain. Statistical Analyses Patient sample size was determined by the rate of variant anatomy in the population with more than 100 patients chosen to achieve a 95% CI. Descriptive statistics were calculated for PSV. To verify the reliability of the nerve morphology method for denoting L5, we determined at which spinal level the L5 nerve exited and expressed this as a percentage agreement with the reference standard labeling. Although the κ coefficient is more widely familiar, it has an anomaly when data are clumped into 1 cell of the cross-tabulation table between raters. Therefore, the more relevant and appropriate prevalence-adjusted bias-adjusted κ, or PABAK, was used to measure interrater and intrarater reliability, which gives the true proportion of agreement beyond chance agreement regardless of unbalanced data patterns. 24. [B]L4-5: At the L4-5 level there is mild circumferential disc bulging and moderate facet arthropathy resulting in mild central canal narrowing. Mild Bilateral foraminal compromise noted. a From the Neuroradiology Division (M.E.P., T.A.H., G.J.S., L.M.S.). General Message Board for Ankylosing Spondylitis and Related Diseases. describe the "squared" appearance of transitional vertebrae on lateral radiographs as the ratio of the AP diameter of the superior vertebral endplate to that of the inferior vertebral endplate as≤1.37. This relative "squaring" and "wedging" represent a spectrum of vertebral body morphologic change and cannot be reliably used to definitively identify an LSTV. Although not initially described, the low back pain of this syndrome is currently thought to be of varying etiologies, subsequently arising from different locations: 1) disk, spinal canal, and posterior element pathology at the level above a transition 5, 8, 9, 12, 20, 24, 31; 2. Do not copy or redistribute in any form!. Please turn JavaScript on and reload the page. were used to classify the lumbosacral anatomy. The level of the iliolumbar ligament and L5 nerve were also documented in all cases. Vertebral numbering was performed as follows: the first 7 vertebrae were considered cervical, and the next 12 vertebrae were considered to be thoracic even in cases with an anomalous number of ribs. 1. The sixth lumbar vertebra is typically located just below the L5 vertebra, making it the lowest vertebra and positioning it next to your tailbone. The extra bone is essentially just a harmless anomaly; sometimes it's because one vertebra failed to fuse with another, but in other cases it's unclear why the bone appeared. L6 vertebrae don't grow overnight. If you have the condition, you've always had it. In the overwhelming majority of people, this condition causes no symptoms. first described the use of a sagittal cervicothoracic MR localizer to better evaluate transitional vertebrae. With a sagittal MR localizer, the vertebrae may be counted in a caudad direction from C2 rather than cephalad from L5. Using a sagittal cervicothoracic MR localizer alone assumes 7 cervical and 12 thoracic vertebrae and does not account for thoracolumbar transitions or allow differentiation of dysplastic ribs from lumbar transverse processes. The addition of a coronal MR cervicothoracic localizer increases the accuracy of enumerating lumbosacral transitional vertebrae 13. Rarely, the L6 vertebra becomes fused to another vertebra, causing back pain. This portion of the spine is also vulnerable to bulging or herniated discs. And because there is an additional bone fitted into the space of five vertebrae, the presence of an L6 can decrease the flexibility of the spine. Lastly, if your spinal cord injury is very low, it might affect your L6 vertebrae. Oh and thanks about the rib bearing definition. I kinda thought that is what they were saying. Axial T2-weighted MR image demonstrates rudimentary facet joints bilaterally ( white arrows ) at the S1-S2 level in this 79-year-old man with a lumbarized S1. Approximately 5% of subjects have been found to have both. 1. described a radiographic classification system identifying 4 types of LSTVs on the basis of morphologic characteristics ( Fig 2 ). Type I includes unilateral (Ia) or bilateral (Ib) dysplastic transverse processes, measuring at least 19 mm in width (craniocaudad dimension) ( Fig 3 ). Type II exhibits incomplete unilateral (IIa) or bilateral (IIb) lumbarization/sacralization with an enlarged transverse process that has a diarthrodial joint between itself and the sacrum ( Fig 4 ). Type III LSTV describes unilateral (IIIa) or bilateral (IIIb) lumbarization/sacralization with complete osseous fusion of the transverse process(es) to the sacrum ( Fig 5 ). Type IV involves a unilateral type II transition with a type III on the contralateral side ( Fig 6 ). Although useful for characterizing the relationship between the transitional segment and the level above or below, this classification system does not provide information relevant to accurate enumeration of the involved segment. .
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Non rib bearing lumbar type vertebral bodies