title: The Impact of Lumbosacral Transitional Vertebrae on Therapeutic Outcomes of Transforaminal Epidural Injection in Patients with Lumbar Disc Herniation.
abstract: Although some studies have evaluated the clinical impact of lumbosacral transitional vertebrae (LSTV), few have attempted to determine an effective conservative treatment method for lumbar disc herniation (LDH) presenting concurrently with LSTV.
  
  
  
  We prospectively enrolled 291 consecutive patients who were followed-up for at least one year after transforaminal epidural injection (TFEI) for LDH. We confirmed the presence of LSTV with Paik et al.'s method, the Castellvi classification, and the Southworth and Bersack method. Clinical outcomes were evaluated with a visual analogue scale (VAS) for pain intensity and the Oswestry Disability Index (ODI) for functional status.
  
  
  
  Of the 291 patients, 47 (16.2%) had LSTV, including 33 with sacralization and 14 with lumbarization, while 244 (83.8%) did not have LSTV. Patients in both groups improved significantly after TFEI in terms of the VAS (P < 0.001) and ODI (P < 0.001) scores. However, LDH patients with LSTV had a worse clinical outcome after six months of TFEI than did those without LSTV, with a significant difference between groups for both the VAS (P < 0.01) and ODI (P = 0.01) scores. LDH patients with sacralization had worse post-treatment clinical outcomes than LDH patients with lumbarization (P < 0.001) or LDH patients without LSTV (P < 0.001).
  
  
  
  Sacralization can reduce the improvement after TFEI among LDH patients, while lumbarization appears to have no direct effect on TFEI outcomes. The presence of sacralization should be identified before TFEI, and if present, patients should be informed that the outcomes of TFEI may not be as good as they would be if sacralization was not present.
authors.affiliation: Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yangju, Korea.
authors.forename: Kang-Min
authors.initials: KM
authors.lastname: Son
authors.affiliation: Department of Family Medicine, Myongji Hospital, Goyang, Korea.
authors.forename: Sun-Mi
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Spine Center and Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea.
authors.forename: Gun Woo
authors.initials: GW
authors.lastname: Lee
authors.affiliation: Spine Center and Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea.
authors.forename: Myun-Hwan
authors.initials: MH
authors.lastname: Ahn
authors.affiliation: Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea.
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Son
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D008161:Lumbosacral Region / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: disc herniation; epidural injection; lumbar spine; lumbosacral transitional vertebrae; transforaminal