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Physiological defects of lumbosacral vertebral arches on computed tomography images in children

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Abstract

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.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Hokkaido Medical Center for Child Health and Rehabilitation, 1-1-240-6 Kanayama, Teine-ku, Sapporo, 006-0041, Japan

    Kazuhisa Yoshifuji & Yoshinori Omori

  2. Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan

    Nobuhito Morota

Authors
  1. Kazuhisa Yoshifuji
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  2. Yoshinori Omori
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  3. Nobuhito Morota
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Contributions

Conceptualization: Kazuhisa Yoshifuji, Yoshinori Omori, and Nobuhito Morota; methodology, analysis of data, and original draft preparation: Kazuhisa Yoshifuji; data collection: Kazuhisa Yoshifuji and Yoshinori Omori; review and supervision: Nobuhito Morota. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kazuhisa Yoshifuji.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics approval

This retrospective study in which all the procedures being performed were part of the routine care was approved by the institutional review board of the Hokkaido Medical Center for Child Health and Rehabilitation (No. 216, October 12th, 2020).

Consent to participate

This study has not contained images or data that may reveal the identities of study participants.

Consent for publication

This study has not contained images or data that may reveal the identities of study participants.

Code availability

All statistical analyses were performed with EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan) on R commander (The R Foundation for Statistical Computing, Vienna, Austria).

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Yoshifuji, K., Omori, Y. & Morota, N. Physiological defects of lumbosacral vertebral arches on computed tomography images in children. Childs Nerv Syst 37, 1965–1971 (2021). https://doi.org/10.1007/s00381-021-05040-y

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  • DOI: https://doi.org/10.1007/s00381-021-05040-y

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