transitional vertebrae w/S1 L5 fusion

[Dolve]

I will try to try to keep my history brief, but hopefully provide enough information for you to get a sense of my situation.

Profile:
I am 39 year old female. Experienced mild/moderate lower back pain in my 20's. Developed severe/dibilating back pain in 2003, shortly after the birth of my only child.  In 2004 I had anterior entry spinal fusion at SI L5 for a torn disc. I also have a transitional vertebrae below my fused area along with mild scoliosis. Although the surgery was considered a "mechanical success", I continued to have extreme pain. After many rounds, with many doctors, my current doctor believes that the fusion is creating pressure on my transistional vertebrae and its disc. I also have possible facet disfunction and damage to the sacrilic joint on my left side.  I have specific pain in this area. Apparently, overcompensation for these above mentioned issues has caused my pelvis to twist, causing more discomfort.

Questions:

How common is this situation: a spinal fusion above a transitional vertebrae? Are there studies available on this topic? I have read a lot of literature about transitional vertebraes, but nothing in conjuction with a spinal fusion.

I would greatly appreciate any direction in finding more information.

Thank you for your time.  

[Charles Rosen, MD]

Dear Dolve,

A transitional vertebra is part lumbar vertebra, and part sacrum.  Namely, it didn’t quite separate completely in development, and is not usually of any consequence.

Whether it is affected by the fusion above it depends largely on whether it is a moving and functioning disc space at that level or not.  If the disc space moves on flexion and extension xrays then it could be a potentially painful segment with degenerated facets and the rest.  If it does not move, then your pain is probably from somewhere else. Injecting different areas like facet joints, then sacroiliac joints later can sometimes help in seeing which relieves the pain, and is therefore the problem to be addressed.

Thanks for your question.  

Dr. Rosen

Charles Rosen, MD
Clinical Professor of Orthopaedic Surgery
Spine Surgery
University of California, Irvine, College of Medicine
Founding Director, UCI Spine Center
101 City Drive, Pavilion III
Orange, CA 92868
[phone]
www.charlesrosenmd.com

[chefcindy46]

Isn't a Transitional Vertebrae just another name used to describe Spina Bifida Occulta? I have X-ray and MRI reports that state SBO at L5-S1, Transitional Vertebrae for sake of this report. And SBO is a Congential Birth Defect, considered by most as being of "no consequence", yet is the only health issue I have to account for the Polyradiculopathy found on NCS/EMG.
And with SBO/Transitional Vertebrae being so Common, and the Millions that have it, suffering the same LBP, leg pain/weakness/numbness, why is it still being considered "OF NO CONSEQUENCE"?