Bel ağrısında nadir ve gözden kaçan iki tanı: Osteitis kondensans ilii ve lumbosakral transizyonel vertebra

Amaç: Bu çalışmada osteitis kondensans ilii (OKİ) ve lumbosakral transizyonel vertebranın (LSTV) sıklığı, bu iki durum arasında ilişki olup olmadığı ve bu durumların yaş ve cinsiyetler arasındaki değişkenliklerinin tespitini amaçladık.Yöntemler: Ocak 2016 -Mart 2016 tarihleri arasında lomber bel ağrısı nedeni ile lomber bilgisayarlı tomografi (BT) çekilmiş 599 hastanın incelemeleri retrospektif olarak değerlendirildi. Bütün BT çekimleri 16 kesitli BT cihazında gerçekleştirildi. Her hasta için yaş, cinsiyet, LSTV anomalisi olup olmadığı bilgisi ve tipi (lumbalizasyon ve sakralizasyon) ile OKİ varlığı ile taraf bilgisi kaydedildi. Bulgular: Değerlendirilen hastaların 577’sinde (%96.3) OKİ saptanmazken 22’sinde (%3.7) saptandı. Değerlendirilen hastaların 522’sinde (%87.2) LSTV saptanmazken 77’sinde (%12.8) saptandı. OKİ saptanan hastaların ortalama yaşı 30.7 (+/- 9.5), saptanmayanlarınki 43.1 (+/- 16.6) yıl idi. OKİ saptanan hastaların 18’i (%81.8) kadın, 4’ü (%18.2) erkekti. OKİ kadın hastalarda ve genç yaş grubunda daha sıktı. LSTV kadın hastaların 41’inde (16.2%) erkek hastaların ise 36 ‘sında (10.3%) gözlendi. LSTV kadın hastalarda daha sık gözlendi. OKİ olan ve olmayan hasta grupları arasında LSTV varlığı ve yokluğu arasında istatiksel fark yoktu. Sonuç: Hem OKI hem de LSTV bel ağrısına neden olan durumlardır. Lomber bel ağrısı ile tetkik edilen hastalarda bu iki tanı dikkate alınmalı, akılda tutulmalıdır.

Anahtar Kelimeler:

Osteitis kondensans ilii, Lumbosakral transizyonel vertebra, Bilgisayarlı tomografi

Rare and overlooked two diagnoses in low back pain: Osteitis condensans ilii and lumbosacral transitional vertebrae

Aim: In this study, we investigated the prevelance of osteitis condensans ilii (OCI) and lumbosacral transitional vertebra (LSTV), relationship of these diseases with age and gender, and whether there was a relationship between these two conditions. Methods: The computed tomography (CT) scans of 599 patients who underwent lumbar CT between January 2016 and March 2016 due to lumbar pain were evaluated retrospectively. All of the CT scans were performed with a 16-slice CT scanner. For each patient; age, gender, LSTV anomaly presence and type (lumbalisation, sacralization), and presence and side information of OCI were recorded. Results: OCI was not detected in 577 patients (96.3%) and was detected in 22 patients (3.7%). LSTV was not detected in 522 patients (87.2%) and was present in 77 patients (12.8%). The mean age of the patients who detected OCI was 30.7 years (+/- 9.5) while without OCI was 43.1 years (+/- 16.6) . 18 (81.8%) of the 22 OCI detected cases were female while 4 (18.2%) cases were male. OCI was more common in young people and female. LSTV was observed in 41 (16.2%) of the female patients while in 36 of the male patients (10.3%). LSTV was observed more frequently in female patients. There was no statistically significant difference between groups with and without OCI disease in terms of presence of LSVT. Conclusion: Both OCI and LSVT are situations that cause back pain. These two diagnoses must be taken into account in examinations made with lumbar pain cause.

Keywords:

Osteitis condensans ilii, Lumbosacral transitional vertebra, Computed tomography,

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1. Atıcı Y. Lumbosacral Junction Anomalies and Low Back Pain. TOTBİD. 2015;14:258–61.
2. Kurt EE, Türkyılmaz AK, Dadalı Y, Erdem HR, Tuncay F. Are Transitional Vertebra and Spina Bifida Occulta Related with Lumbar Disc Herniation and Clinical Parameters in Young Patients with Chronic Low Back Pain? Eurasian J Med. 2016;48:177-80.
3. Suyabatmaz Ö, Çağlar NS, Tütün Ş, Özgönenel L, Burnaz Ö, Aytekin E. Assessment of the Effect of Back School Therapy in Patients with Low Back Pain. Istanbul Med J. 2011;12(1):5-10.
4. Baysal Ö, Baysal T, Altay Z, Füdan F. The Relationship Between Types of Transitional Vertebrae and Disc Degeneration. Ege Fiz Tıp Reh Der. 2001;7:45-9.
5. Demirdal ÜS, Haktanır A, Yaman F. Low Back Pain Due to the Osteitis Condensans Ilii. Turkish Journal of Osteoporosis. 2013;19:48-51.
6. Alkan BM, Karaarslan H, Eroğlu E, Alemdar A, Yamçiçi S, Ardıçoğlu S. Osteitis Condensans Ilii: Case Report. Open Journal of Rheumatology and Autoimmune Diseases. 2011;1:1-4.
7. Ayoub MA. Refractory osteitis condensans ilii: Outcome of a novel mini-invasive surgical approach. International Orthopaedics (SICOT). 2013;37:1251–6.
8. Jenks K, Meikle G, Gray A, Stebbings S. Osteitis condensans ilii: a significant association with sacroiliac joint tenderness in women. International Journal of Rheumatic Diseases. 2009;12:39–43.
9. Nardo L, Alizai H, Virayavanich W, Liu F, Hernandez A, Lynch JA, et al. Lumbosacral transitional vertebrae: association with low back pain. Radiology. 2012 Nov;265(2):497-503.
10. Uçar D, Uçar BY, Coşar Y, Emrem K, Gümüşsuyu G, Mutlu S, et al. Retrospective cohort study of the prevalence of lumbosacral transitional vertebra in a wide and well-represented population. Arthritis. 2013;2013:461425.
11. Konin GP, Walz DM. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. AJNR Am J Neuroradiol. 2010;31:1778–86.
12. Hughes RJ, Saifuddin A. Numbering of Lumbosacral Transitional Vertebrae on MRI: Role of the Iliolumbar Ligaments. AJR. 2006;187:59-66.
13. Sekharappa V, Amritanand R, Krishnan V, David KS. Lumbosacral Transition Vertebra: Prevalence and Its Significance. Asian Spine J. 2014;8:51-8.