title: Prevalence and clinical significance of lumbosacral transitional vertebra (LSTV) in a young back pain population with suspected axial spondyloarthritis: results of the SPondyloArthritis Caught Early (SPACE) cohort.
abstract: OBJECTIVE
  To determine in a cohort of young patients with suspected axial spondyloarthritis (axSpA), the prevalence of lumbosacral transitional vertebra (LSTV), its association with local bone marrow edema (BME) and lumbar spine degeneration, and the potential relationship with MRI findings and clinical signs of axSpA.
  
  
  METHODS
  Baseline imaging studies and clinical information of patients from the SPondyloArthritis Caught Early-cohort (back pain ≥3 months, ≤2 years, onset <45 years) were used. Two independent readers assessed all patients for LSTV on radiography, and BME-like and degenerative changes on MRI. Patients with and without LSTV were compared with regard to the prevalence of MRI findings and the results of clinical assessment using Chi-squared test or t test.
  
  
  RESULTS
  Of 273 patients (35.1% male, mean age 30.0), 68 (25%) patients showed an LSTV, without statistical significant difference between patients with and without axSpA (p = 0.327). Local sacral BME was present in 9 out of 68 (13%) patients with LSTV and absent in patients without LSTV (p < 0.001). Visual analogue scale (VAS) pain score and spinal mobility assessments were comparable.
  
  
  CONCLUSIONS
  LSTV is of low clinical relevance in the early diagnosis of axSpA. There is no difference between patients with and without LSTV regarding the prevalence of axSpA, pain and spinal mobility, and a BME-like pattern at the pseudoarticulation does not reach the SI joints.
authors.affiliation: Department of Radiology, Leiden University Medical Center, 2333, ZA, Leiden, The Netherlands. f.de_bruin@lumc.nl.
authors.forename: F
authors.initials: F
authors.lastname: de Bruin
authors.affiliation: Department of Radiology, Leiden University Medical Center, 2333, ZA, Leiden, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Ter Horst
authors.affiliation: Department of Radiology, Leiden University Medical Center, 2333, ZA, Leiden, The Netherlands.
authors.forename: J L
authors.initials: JL
authors.lastname: Bloem
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van den Berg
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Hooge
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van Gaalen
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Dagfinrud
authors.affiliation: Department of Rheumatology, Groene Hartziekenhuis, Gouda, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Oosterhout
authors.affiliation: Department of Rheumatology, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Landewé
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Department of Radiology, Leiden University Medical Center, 2333, ZA, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Reijnierse
mesh_terms: D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000150:complications*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D025241:Spondylarthritis / Q000150:complications* / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Axial spondyloarthritis; Disc degeneration; Lumbosacral transitional vertebra