Letter to the Editor: “Quantitative measurements at the lumbosacral junction are more reliable parameters for identifying and numbering lumbosacral transitional vertebrae”
by Niladri Kumar Mahato (mahato@ohio.edu)
Quantitative measurements at the lumbosacral junction are more reliable parameters for identifying and numbering lumbosacral transitional vertebraeDear Editor-in-Chief,
The author of this communication reads with great interest the article titled ‘Quantitative measurements at the lumbosacral junction are more reliable parameters for identifying and numbering lumbosacral transitional vertebrae’ by Suying Zhou et. al., recently published in this journal [1]. This author would like to congratulate Zhou et. al. for presenting their quantitative and comparative findings related to LSTV (lumbosacral transitional vertebrae) imaging from a large patient cohort. Also valuable are the parameters envisioned and developed to determine such variations at the lumbosacral junction, reporting them as a diagnostically distinct approach to detect these structural alterations.
The authors of the article have clearly delineated certain limitations associated with their study. Nevertheless, outside these limitations, the study is particularly interesting in the way anatomical parameters have been used to delineate subtle morphological (and functional) changes associated with these transitions, especially as visualized with imaging and understood in context of the functional role of the anatomical orientation, as reported earlier [2]. As briefly suggested in the article, in terms of attachment of the psoas muscle and considering the overall configurational adaptations occurring in the LSTV-affected lumbar spine, assessment of LSTV-induced alterations in the parameters suggested could be best evaluated in different weight bearing conditions of the spine [3, 4]. Quantitative and biomechanical assessment of spinal curvatures, range of motion testing in different degrees-of-freedom specifically in partial LSTV models have been reported using computational simulations [5].
Experimental, dynamic imaging techniques involving different modalities have been used to study intervertebral motion at lumbar spine motion-segments and could be interesting tools to investigate the functional effects of these variations in flexion-extension, side-bending and rotations, further [6]. Additionally, on a slightly different note, imaging for end-of-range (RoM) assessment of motion segments in LSTV may not be the ideal way to defining hypo- and hyper- mobility associated with such segments since a segmental instability and hyper mobility are surmised to be most prominently demonstrated at the ‘neutral zones’ of the RoM [7].
More such studies are required to validate the diagnostic efficiency of such quantitative approaches to detect LSTV anomalies. The authors have offered an important alternative idea to approach LSTV imaging considering the currently available options. Congratulations to the authors.
Thank you.