Spinal transitional zones syndromes

The spinal transitional zone (STZ) is defined as the vertebral zone located between two adjacent spinal vertebrae with various differences in their “posterior element” orientation and differing degrees of mobility. A “Transitional lumbosacral vertebra” is defined as a vertebra that shows elongation of its transverse process with variable degrees of fusion to the “First” sacral (S1) segment

The spinal transitional zones (STZs) are prone to vertebral rotational malalignment (Vertebral sublaxation complex) with various subcutaneous fat, enthesis, and muscle (Cellulo-teno-periosteo-myalgic) manifestations. Four vertebral transitional zones are described:

1. Cervico-occipital junctional zone: is defined as a headache that is caused by a lesion within the cervical spine or in the soft tissues of the neck detected by clinical, laboratory, and/or by imaging evidence

2. Cervico-thoracic junctional zone: refers to the manifestations of vertebral sublaxation or facet joint abnormalities between C5-6 or C6-7 vertebrae

3. Thoraco-lumbar junctional zone: also known as “Maigne syndrome”, “Dorsal ramus syndrome” and T12-L2 segmental vertebral cellulotenoperiosteomyalgic syndrome”; refers to the manifestations of vertebral sublaxation or facet joint abnormalities between T12-L2 vertebrae

4. Lumbo-sacral junctional zone: is a common finding in plain radiography of the general population reaching up to 20%. Two main lumbosacral transitional vertebrae are described: Lumbaralized of S1 vertebra & Sacralization of L5 vertebra

Malalignment / sublaxation of the vertebrae in the STZs can result in somato-visceral symptoms according to the myotome / dermatome involved. STZ syndromes, elegantly described by the French osteopath Robert Maigne, are characterized by a triad (Not necessary all 3 present together) of:

1) Cellulalgia: described clinically as painful, deep, burning-like subcutaneous tissue pain, swelling and induration in all or part of the affected dermatome

2) Myalgia: described clinically as painful, taut bands of muscle fibers - trigger points - localized in some muscles of the affected myotome

3) Enthesitis: described clinically as hypersensitivity of the teno-periosteal insertions (Entheses) of the affected sclerotome

 

Selected references

1. Maigne R, Nieves WL. Diagnosis and treatment of pain of vertebral origin. 2005; CRC Press; 2nd edition

http://www.amazon.com/Diagnosis-Treatment-Vertebral-Origin-Management/dp/0849331218/ref=sr_1_1?ie=UTF8&qid=1439651657&sr=8-1&keywords=maigne

2. Meloche JP et al. Painful intervertebral dysfunction: Robert Maigne’s original contribution to headache of cervical origin. Headache 1993; 33(6): 328-334

3. Demondion X et al. The posterior lumbar ramus: CT-anatomic correlation and propositions of new sites of infiltration. AJNR Am J Neuroradiol 2005; 26: 706–710

4. Hughes RJ et al. Imaging of lumbosacral transitional vertebrae. Clinical Radiology 2004; 59: 984–991

5. Bron JL et al. The clinical significance of lumbosacral transitional anomalies. Acta Orthop Belg 2007; 73: 687-695

6. Konin GP et al. Lumbosacral transitional vertebrae: Classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol 2010; 31: 1778–86

7. Hughes RJ et al. Imaging of lumbosacral transitional vertebrae. Clinical Radiology 2004; 59: 984-991

8. Castellvi AE et al. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine 1984; 9: 493-495