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Purpose: To investigate the association of spinal anomalies with lumbar spondylolysis and spina bifida occulta (SBO)., Methods: A total of 1190 patients with thoracic, abdominal, and pelvic computed tomography scans available were categorized according to the number of presacral (thoracic and lumbar) mobile vertebrae and the presence or absence of lumbosacral transitional vertebrae (LSTV). The prevalence of spondylolysis and SBO and the association of spinal anomalies with these disorders were evaluated., Results: Normal morphology (17 mobile vertebra with no LSTV) was found in 607 men (86.5%) and 419 women (85.9%) and about 14% of patients had anomalies. Spondylolysis was found in 74 patients (6.2%), comprising 54 men (7.7%) and 20 women (4.1%). SBO involving the lumbar spine was found in 9 men (1.3%) and 2 women (0.4%). Spondylolysis was significantly more common in men with 18 vertebrae without LSTV (21.1%) than in those with 17 vertebrae without LSTV (7.2%) (p = 0.002). The prevalence of spinal anomalies was 55.6% in men and 50.0% in women with SBO that included a lumbar level was significantly higher than in both men (13.5%, p < 0.001) and women (4.8%, p = 0.003) without SBO., Conclusion: These findings indicate that there is a relationship between spinal anomalies and both spondylolysis and SBO, which may lead to elucidation of the mechanism of onset of spondylolysis and improve its treatment and prognosis. Awareness that patients with SBO involving the lumbar spine have an increased likelihood of a spinal anomaly may help to prevent level errors during spinal surgery., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: We investigated the prevalence of Modic changes (MCs) and associated pathologies in pediatric patients., Methods: A total of 368 MRI obtained for 240 male and 128 female patients under the age of 18 years with complaints of low back/leg pain were retrospectively examined. All changes in signal intensity in the vertebral endplate and subchondral bone on MRI were defined as MCs. We investigated the relationship between MCs and underlying diseases, including lumbar spondylolysis/spondylolisthesis, and conditions of the growth plate in cases with MCs. The degree of disc degeneration in patients with MCs was evaluated using the Pfirrmann grading system., Results: MCs were identified in six patients (1.6%). In five of the six patients, the signal intensity changes were localized to the anterosuperior endplate of the affected vertebra; the MCs were associated with anterior apophyseal ring fracture and an open growth plate in all these cases. Disc degeneration was classified as Pfirrmann grade I in three patients and grade II and III in one patient each. One patient had type I changes associated with grade IV disc degeneration and herniation and no sign of an open growth plate., Conclusion: The prevalence of MCs in pediatrics patients was much lower than the rates reported in adults. Most MCs were associated with an anterior apophyseal ring fracture. If Modic type changes are seen in immature vertebrae of pediatric patients, growth plate lesions such as apophyseal ring fractures should be considered., Level of Evidence: Diagnostic: individual l cross-sectional studies with consistently applied reference standard and blinding., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Abnormalities of the lumbar nerve tract caused by congenital variations or high nerve root take-off angles are difficult to visualize. Diffusion-weighted magnetic resonance neurography (DW-MRN) has recently been introduced for imaging of the lumbosacral region. The aims of this study were to identify lumbar nerve tract abnormalities caused by congenital variation or a high nerve root take-off angle using DW-MRN and to assess the diagnostic value of this imaging modality., Methods: A total of 573 magnetic resonance images from 575 patients (261 men, 314 women; mean age 58.5 years) with low back/leg pain were retrospectively analyzed. We classified congenital variations in the lumbar nerve roots using the Neidre and MacNab criteria and investigated nerve roots with a take-off angle of 60° or more., Results and Discussion: Congenital variations were identified in 8 patients (9 nerve roots, 1.6%). The most commonly identified variation was in the sacral nerve root (n = 5) followed by the L4 (n = 3) and L5 (n = 1) nerve roots. All variations identified were on the left side. There were 3 cases of type 1a variation, 1 of type 1b, 1 of type 2, and 4 of type 3. In total, 210 (36.6%) of the magnetic resonance images showed high nerve root take-off angles at the intervertebral foramen that was caused by disk herniation, spondylolisthesis, or osteophytes with degeneration. Patients with high nerve root take-off angles were significantly older than those without (P < 0.05). These slides can be retrieved under Electronic Supplementary Material.

Purpose: Several papers examined the vascular anatomy of the lumbosacral region using cadavers with angiography. However, few reports used CT angiography, and discussion on variations of fourth lumbar, fifth lumbar, and lumbar branch of iliolumbar arteries were limited. To clarify the vascular variations around the lower lumbar spine including the lumbosacral region, particularly at the posterior elements, we performed anatomical analysis using computed tomography (CT)., Methods: Extra-osseous arteries surrounding the lumbar spine including the lumbosacral region were evaluated by two orthopedic surgeons independently, using 323 consecutive abdominal contrast-enhanced multi-planner CT scans that were taken for surgical plans in colon cancer patients. Subjects were 204 men and 119 women, whose ages ranged from 15 to 89 years (mean 66.5)., Results: Each segmental artery was visible at the L1-4 spinal levels, running from the vertebra through the lamina in 91.0 % on the right side, in 90.7 % on the left side, while it was visible in 4.6 % on the right side, in 8.7 % on the left side at the L5 level. The extra-osseous arterial supply to the L5 lamina was basically provided by two vessels on each side. One was mostly derived from the L4 segmental artery (right: 92.6 %; left: 92.0 %) that was distributed around the superior articular process, the other was derived from the iliolumbar artery (right: 62.9 %; left: 55.7 %) that was distributed around the inferior articular process through the lamina. There were mainly four combination patterns of those arteries. These combinations, which had been considered as regular patterns in textbooks, were observed in approximately 50 % (right: 55.7 %; left: 48.6 %) of patients., Conclusion: Various distributions of arteries around the lower spine were identified.

Purpose: Lumbar spondylolysis, a stress fracture of the pars interarticularis in the lumbar spine, is often precipitated by trauma, but there may be a congenital predisposition to this condition. There have been few studies on spondylolysis in young children, despite their suitability for studies on congenital defects. The aim of this study was to identify the clinical features of lumbar spondylolysis in elementary school age children in order to elucidate its pathogenesis., Methods: Thirty lumbar spondylolysis patients (23 boys, 7 girls, including a pair of twins; mean age 9.5 years, age range 5-12 years) were studied. Patient data on history of athletic activity, symptoms at first consultation, and radiological findings such as spinal level, stage of the stress fracture, and skeletal age were collected., Results: Among the 30 patients, 27 (21 boys, 6 girls) had L5 spondylolysis (90.0 %). Only 2 patients had no history of athletic activity at the first consultation. All patients, except for 2 whose diagnosis was incidental, complained of low back pain. In the 27 patients with L5 spondylolysis, 17 (63.0 %) had terminal-stage fracture and 25 (92.6 %) had spina bifida occulta (SBO) involving the S1 lamina. Sixteen of the 27 (59.3 %) had SBO involving the affected lamina (L5) and S1 lamina. In contrast, the 3 patients with L3 or L4 spondylolysis had no evidence of SBO. With respect to skeletal age, 23 of the 27 L5 spondylolysis patients (85.2 %) were in the cartilaginous stage while the remaining 4 patients were in the apophyseal stage., Conclusion: Lumbar spondylolysis in elementary school age children was commonly a terminal-stage bone defect at L5, which was not necessarily related to history of athletic activity and was sometimes asymptomatic. It was often associated with SBO, indicating a possible congenital predisposition. These findings may provide further insight into the pathogenesis of lumbar spondylolysis.