Objective

Physiological midline defects of the lumbosacral vertebral arches on radiographs must be distinguished from pathological spina bifida. To date, however, this has not been examined, except for some reports based on plain radiography. The aim of this study is to accurately define the rate and distribution of physiological defects by computed tomography (CT) imaging.

Methods

A total of 115 patients aged 0 months to 16 years (median age, 4 years) who underwent CT scans for abdominopelvic disorder not involving the lumbosacral spine were retrospectively analyzed. The lumbosacral spines were collaterally identified on these images.

Results

In the lumbosacral spine excluding the sacral hiatus, the rate of physiological defects was 66.1% (95% confidence interval [CI]: 56.7–74.7%), and the mean number of defective vertebral arches was 1.6 per patient (95% CI: 1.3–1.9). The rate and mean number of defects were significantly higher in the group of patients less than 6 years old (84.3%, 2.2/patient) than that of patients 6 years old or older (37.8%, 0.5/patient) (p < 0.001 and p < 0.001, respectively). The defect rates by spinal level were S3 (57.4%), S1 (47.8%), S2 (34.8%), L5 (13.0%), L4 (2.6%), and L3 (0.9%) in descending order.

Conclusions

Physiological defects were found more commonly at an earlier age and predominantly existed adjacent to the sacral hiatus (S3) and around S1. Understanding the detection rate and distribution features of defects more precisely on CT images will contribute clinically supportive information to distinguish between physiological defects and pathological spina bifida.

中文翻译：

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儿童计算机断层扫描图像上腰骶椎弓的生理缺陷

客观的

X光片上腰骶椎弓的生理性中线缺陷必须与病理性脊柱裂相鉴别。然而，迄今为止，除了一些基于平片的报告外，还没有对此进行检查。本研究的目的是通过计算机断层扫描 (CT) 成像准确定义生理缺陷的发生率和分布。

方法

回顾性分析了 115 名年龄在 0 个月至 16 岁（中位年龄，4 岁）的患者，这些患者因不累及腰骶椎的腹盆腔疾病而接受 CT 扫描。腰骶棘在这些图像上被侧枝识别。

结果

在不包括骶骨裂孔的腰骶椎中，生理缺陷率为 66.1%（95% 置信区间 [CI]：56.7-74.7%），缺陷椎弓的平均数为每位患者 1.6 个（95% CI：1.3） –1.9）。6岁以下患者（84.3%，2.2/人）的缺陷率和平均数显着高于6岁及以上患者（37.8%，0.5/人）（p  < 0.001和p  < 0.001，分别）。脊柱水平缺陷率依次为 S3 (57.4%)、S1 (47.8%)、S2 (34.8%)、L5 (13.0%)、L4 (2.6%) 和 L3 (0.9%)。

结论

生理缺陷在较早的年龄更常见，主要存在于骶骨裂孔 (S3) 附近和 S1 周围。在 CT 图像上更准确地了解缺陷的检出率和分布特征，将为区分生理缺陷和病理性脊柱裂提供临床支持信息。