Identification and prediction of transitional vertebrae on imaging studies: Anatomical significance of paraspinal structures

The aim of our study was to examine the locational distribution of paraspinal structures on MRI and to determine any predictable parameters that may be used for the identification of transitional vertebra (TV). We enrolled 534 patients who underwent MRI of their lumbosacral spine. The locations of the paraspinal structures, such as aortic bifurcation (AB), IVC confluence (IC), right renal artery (RRA), celiac trunk (CT), SMA root (SR), and iliolumbar ligament (ILL), were determined using "cross link" in PACS. We also assessed the morphology of the TV. The MRI showed that the most common site of the paraspinal structures in the normal group was AB at the lower L4, IC at the L4-5 disc space, RRA at the L1-2 disc space, CT at the T12-L1 disc space, SR at the upper L1, and ILL at the L5. The frequency of TV was 23.8% (lumbarization, 9.9%; sacralization, 13.9%). The paraspinal structures of the S1 lumbarization were positioned more toward the caudal location, whereas the paraspinal structures of the L5 sacralization were positioned more toward the cephalic location (P < 0.01). In conclusion, AB, IC, RRA, CT, SR, and ILL are useful landmarks for predicting the presence of TV on MRI. TV is possible when these paraspinal structures are in positions outside of the frequent locations.