A Case of Severe Low Back Pain Associated with Richard Disease (Lumbosacral Transitional Vertebra)

Abstract

The imaging findings in some cases of low back pain are difficult to describe and the pathophysiology is not clear because subjective findings are usually difficult to document. This report concerns a rare case about the lumbosacral joint causing persistent severe back pain which in itself does not usually have any pathological meaning. We describe the diagnosis, treatment, and outcome of a patient suffering from low back pain with lumbosacral transitional vertebra. The radiological examination showed the congenitally malformed transverse processes of the 5th lumbar vertebra to create a facet joint-like shape at the sacral ala region on both sides. Surgery resulted in immediate disappearance of the low back pain. When the lumbosacral junction shows some instability without fusion, the joint-like region could be the cause of low back pain. The lumbosacral transitional vertebra may be associated with low back pain. Electric denervation of the space between the transverse process of 5th lumbar vertebra and sacral ala is minimally invasive and effective for pain eradication.

Electric denervation - Richard disease - lumbosacral junction - lumbosacral transitional vertebrae

References

• 1 Adams Z B. A case of scoliosis relieved by operation on the transverse process of one of the vertebra.  Am J Ortho Surg. 1910;  8 299-305
• 2 Castellvi A E, Goldstein L A, Chan D P. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects.  Spine. 1984;  9 493-495
• 3 Fujita Y, Fujita T. A clinical study on the relation between low back pain and lumbosacral transitional vertebrae.  Seikeigeka to Saigaigeka. 1994;  43 1239-1242 (in Japanese with English abstract)
• 4 Stinchfield F E, Sinton W A. Clinical significance of the transitional lumbosacral vertebra.  JAMA. 1955;  157 1107-1109
• 5 Richard A J. Pain in the lumbosacral region associated with congenital malformation of the transverse processes of the fifth lumbar vertebra.  AJR. 1919;  6 434-439
• 6 Moore B H. Sacralization of the fifth lumbar vertebra.  J Bone Joint Surg. 1925;  7 271-278
• 7 Bogduk N. The innervation of the lumbar spine.  Spine. 1983;  8 286-293
• 8 Taguchi T, Oda H, Kido K, Yamagata S, Ohtani T, Toyota K, Kawai S. Percutaneous electrical denervation of posterior medial branch for lumbar posterior joint pain.  Seikeigeka to Saigaigeka. 1991;  39 1530-1532 (in Japanese with English abstract)