The Clinical Significance of Lumbosacral Transitional Vertebrae on the Surgical Outcomes of Lumbar Discectomy: A Retrospective Cohort Study of Young Adults.
OBJECTIVE
To evaluate whether the presence of lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of microdiscectomy (MD) in young adults with lumbar disc herniation.


METHODS
We retrospectively included 398 patients who were followed-up for at least 2 years after MD for lumbar disc herniation at L4/5 (disc above the LSTV). The patients were divided into 2 groups. Group A was made up of 31 patients in whom LSTV was detected. Group B, in contrast, was made up of 35 patients in whom LSTV was not detected. The LSTV were classified using plain radiographs and three-dimensional computed tomography by Castellvi et al. The primary outcome measure was pain intensity at each follow-up visit assessed with visual analog scale for back and leg. Secondary outcome measures included the Oswestry Disability Index, a 12-item short-form health survey for quality of life, complications, and recurrence rate.


RESULTS
After surgery, the visual analog scale scores for the back and leg decreased significantly in both groups. However, the back pain intensity in group A worsened at 12 and 24 months postoperatively. The Oswestry Disability Index scores and 12-item short-form health survey (both mental and physical) worsened at 12 and 24 months postoperatively in group A. Two cases of reherniation (6.5 %) were observed in group A, who required reoperation.


CONCLUSIONS
LSTV can limit a patient's clinical improvement after MD with regard to pain intensity and recurrence. Caution must be taken when a patient is scheduled to undergo surgery.
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea. Electronic address: ahnsangsoak@hanmail.net.
Sang-Soak
SS
Ahn
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea.
Dong-Kyu
DK
Chin
Department of Radiology, Dong-A University Medical Center, Busan, Korea.
Sang-Hyeon
SH
Kim
Department of Radiology, Dong-A University Medical Center, Busan, Korea.
Dong-Won
DW
Kim
Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea.
Byung-Hun
BH
Lee
Department of Neurosurgery, 21 Century Hospital, Jeju, Korea.
Min-Geun
MG
Ku
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D017586:Diskectomy; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging; D008297:Male; D010147:Pain Measurement; D011379:Prognosis; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
Disc herniation; Discectomy; Lumbar spine; Lumbosacral transitional vertebrae fusion