Transitional vertebrae

　　1. Etiology

　　The etiology is unknown.

　　2. Pathogenesis

　　A normal spine includes 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae, and 4 coccygeal vertebrae. During the 4th to 7th weeks of embryonic development, each vertebral segment begins to differentiate. The ossification centers of the vertebral bodies, bilateral vertebral arches, and lateral additional ossification centers appear respectively during the 10th, 20th, and 30th weeks of embryonic development. Vertebral bodies, vertebral arches, and lateral parts are healed before 8 years of age. The two vertebral arches fuse between 7 and 15 years of age. Around the age of 15, a growth plate appears on the upper and lower surfaces of each vertebral body, and an additional ossification center appears on the tympanic surface or below. By the age of 18, the growth plates begin to fuse with the vertebral bodies, and by the age of 30, the 5 sacral vertebrae fuse into a sacrum.

　　During this process, certain factors affecting development can cause atavism and lead to transitional vertebral bodies.

　　1. Pain: At the initial stage, local pain is often not obvious. As the lesion progresses and stimulates or compresses the adjacent nerve roots, such as intercostal neuralgia in the thoracic vertebrae, or stimulation or compression of the lumbar plexus causing lumbar leg pain.

　　2. Swelling: The skin color usually appears normal, with slight heat sensation locally. Swelling gradually increases.

　　3. Functional disorders: The onset of vertebral functional disorders in patients is usually earlier. Muscle protective spasms make it difficult to bend over and squat down carefully to pick up objects, etc.

　　4. As the disease progresses, bone and joint or vertebral bone destruction occurs, the above-mentioned specific posture remains unchanged and further develops, joint movement is further restricted, and deformities appear, with the spine often showing deformities.

　　First, the symptoms of lumbar sacral transitional vertebral bodies

　　1. Overview:

　　Generally, such malformations do not cause any symptoms, especially during the adolescent period. The diagnosis and classification of malformations mainly depend on X-ray films. For patients with lumbar sacral malformations and lumbar pain, other diseases should be considered first and a more comprehensive examination should be conducted. Only when no clear etiology can be found should it be considered that the malformation is the cause, among which the most common are the kissing spine and floating spine malformations.

　　2. The symptomatology and pathogenesis of transitional vertebrae:

　　(1) Increase in vertebral segment load: Although lumbar sacralization can increase the stability of the lower lumbar region, the load on the other lumbar segments is increased, leading to fatigue and degeneration of the vertebral bones.

　　(2) Weakening of vertebral stability: Whether it is thoracic lumbarization or sacral lumbarization, it increases the number of lumbar vertebrae and extends the lever arm, leading to the weakening of the stability of lumbar vertebral segments, which is prone to injury, fatigue, and degeneration.

　　(3) Unbalanced load-bearing of vertebrae: For patients with asymmetric lumbar sacralization on both sides, the side that has not fused or fused less is prone to cause peripheral soft tissue injury due to high activity; on the other side, where a pseudojoint has formed with the iliac crest, due to the fact that this kind of joint is a幼稚型 joint, it is difficult to absorb the shock caused by external force and is prone to develop destructive arthritis.

　　(4) Nerve entrapment: When the lumbar sacralization occurs, the dorsal branch of the spinal nerve running near the transverse process of the fifth lumbar vertebra is prone to be compressed by the enlarged transverse process and show symptoms, especially more pain during extension and lateral flexion.

　　(5) Reflex sciatica: It is very rare for sciatica to be caused by the stimulation or compression of the sciatic nerve or its constituent branches by the deformity itself, and sciatica usually appears reflexively due to the stimulation of peripheral terminal nerve branches. Local (pain point) block therapy can make it disappear.

　　Second, Classification

　　1, Lumbar sacralization:

　　It refers to the whole or partial transformation of the fifth lumbar vertebra into a sacral shape, making it part of the sacral bone block. Clinically, it is more common to see one or both sides of the fifth lumbar vertebrae developing wing-like processes and fusing with the sacrum to form one piece, and it often forms a pseudojoint with the iliac spine. A few cases are where the fifth lumbar vertebral body (including the transverse process) fuses with the sacrum to form one piece, and this kind of deformity is more common.

　　2, Thoracic lumbarization:

　　It refers to the twelfth thoracic vertebra losing its ribs to form a lumbar-like shape. If the fifth lumbar vertebra does not have sacralization, it still presents a lumbar shape and has the function of the lumbar vertebra.

　　3, Sacral lumbarization:

　　It refers to the first sacral vertebra evolving into a lumbar-like shape, which has a very low incidence and is usually found incidentally during radiography, usually without symptoms.

　　4, Sacrococcygeal fusion:

　　It refers to the fusion of the sacrum and coccyx into one piece, which is more common than the former.

　　The disease of the transition vertebral column is generally caused by accumulated injury, and accumulated injury will aggravate the symptoms, so the focus of prevention is to reduce accumulated injury. One should maintain a good sitting posture, and the bed during sleep should not be too soft. Workers who need epidural injection of hormones should pay attention to the height of the table and chair, and change their posture regularly. Workers who need to bend over frequently during professional work should stretch their waist and chest regularly, and use a wide belt. It is necessary to strengthen the training of the lumbar and thoracic muscles, increase the intrinsic stability of the spine, and pay special attention to the exercise of the lumbar and thoracic muscles for those who have used lumbar belts for a long time, in order to prevent the adverse consequences of disuse muscle atrophy. If it is necessary to bend over to pick up something, it is best to use a flexed hip and knee squatting method to reduce the pressure on the posterior intervertebral disc of the lumbar spine.

　　X-ray examination can show the transition vertebral bodies and their classification. X-ray film is the most basic and main examination method for detecting the transition vertebral body, which can clearly determine the existence of the transition vertebral body and judge whether pseudoarthrosis has formed. It is particularly helpful for localization diagnosis of diseases that require surgery, such as intervertebral disc herniation.

　　1. What foods are good for transitory spondylolisthesis patients to eat:Should be light in taste, eat more vegetables and fruits, supplement vitamins, rationally match the diet, pay attention to nutritional balance, and eat food rich in calcium, such as milk, cheese, yogurt, soy products; eat more fresh green vegetables.

　　2. Transitory Spondylolisthesis Diet:Avoid eating food cooked in iron pots. Excessive iron in joints can lead to iron saturation, and it and free iron can promote the attack of joints.

　　I. Treatment

　　1. Treatment Principles

　　(1) The main treatment is non-surgical, among which the protection of the lumbar spine and the lumbar and thoracic muscle (or abdominal muscle) exercise should be emphasized in particular.

　　(2) For patients with other organic diseases, a unified treatment plan should be arranged.

　　(3) For patients who have not responded to regular non-surgical treatment and have affected their work and life, surgical treatment should be performed on the basis of excluding other diseases.

　　2. Non-surgical Treatment

　　(1) Basic Requirements: Improve and protect good sleep and work postures.

　　(2) Functional Exercise: Active and regular lumbar and thoracic muscle exercises, for patients with lumbar spinal canal stenosis, it should be emphasized to exercise the rectus abdominis.

　　(3) Lumbar Protection: A wide belt can be used to protect the lumbar spine, and a leather lumbar corset or plaster lumbar corset can be used when symptoms occur.

　　(4) Other Therapies: Physical therapy or external application of medicine can be chosen. For patients with clear trigger points or pressure points, closed therapy can be performed.

　　3. Surgical Treatment

　　(1) Osteotomy Decompression Surgery: Mainly used for the fifth lumbar transverse process hypertrophy or pseudoarthrosis stimulation, compression of nerve branches due to sacralization, a segment of the hypertrophied transverse process can be removed.

　　(2) Joint Fusion Surgery: For patients with simple (unilateral or bilateral) pseudoarthrosis (L5 transverse process and ilium) traumatic arthritis, bone graft fusion surgery can be performed. However, this operation is relatively deep, and attention should be paid during operation.

　　(3) Neurotomy (or Decompression) Surgery: For patients with clear nerve branches, they can be decompressed and freed at the pressure point; if it is not possible to obtain decompression, they can be cut.

　　(4) Vertebral Fusion Surgery: For patients with functional disorders of multiple lumbar and sacral vertebrae who have not responded to conservative treatment, vertebral fusion surgery at the lumbar and sacral segments can be performed.

　　II. Prognosis

　　The prognosis is good.