More often than not, the existence of an L6 does not contribute directly to troublesome spinal conditions. In fact, this vertebra is subject to the same potentially debilitating conditions most people experience at the L5 level.
Another difference is the way doctors refer to conditions associated with this transitional vertebra. Rather than speak of it in terms of the L5 to L6 level, it is generally referred to as the L6 to S1 level — denoting an association with the sacral region just below the lumbar vertebrae. Occasionally, the L6 vertebra can become sacralized, which means it is attached to the sacrum by a rudimentary joint that creates additional motion.
Therefore, a greater potential for motion-related stress can lead to lower back pain. Other conditions that affect this vertebra include a herniated disc, a bulging disc, spinal stenosis, degenerative disc disease and osteoarthritis, which can occur at any level of the spine.
Doctors who discover the presence of a sixth lumbar vertebra through the use of an MRI, X-ray or CT scan are likely to prescribe the same type of conservative treatments for chronic pain management as they would for someone without an L6.
These methods of treatment include pain medication, physical therapy, behavior modification and more. Occasionally, conservative treatment proves ineffective and a doctor might suggest seeing if you are a candidate for surgery, such as the minimally invasive procedures offered at Laser Spine Institute.
The outpatient procedures at Laser Spine Institute lead to shorter recovery times and safer and effective alternatives when compared to traditional open spine operations. Minimally invasive decompression Discectomy Facet thermal ablation Foraminotomy Laminotomy. Cervical disc replacement Lateral lumbar interbody fusion SI joint fusion Posterior cervical fusion. Patient care Am I a candidate? For example, the bone may form at the point where the lumbar section of the spine connects with the sacrum section.
Trouble is most common when the addition begins to grow, or when it causes the other bones to shift and rub against each other. Fully-formed extra vertebrae can cause chronic pain in the back and hips as a result of increased pressure. Crowding can move the spine out of alignment and push other bones, such as the hip and pelvis , out of place.
Pain in other parts of the body is also common if nerve groups are affected. The spinal column is rich with nerves running to all parts of the body, and depending on where the addition is located, pain can be felt almost anywhere.
Professional health care providers are usually able to identify an extra spinal bone through magnetic resonance imaging MRI scans or X-rays of the spine. Screens that turn up the extra bone are, in most cases, actually looking for something else. Patient demographic characteristics including age, weight, height, and body mass index BMI were compared using independent samples t tests. Variables expressed as frequencies were compared using the chi-squared test.
Thirty-two volunteers had missing X-ray images or did not meet the exclusion criteria Fig. In total, volunteers were included in this study. A schematic illustrating the research process and distribution of asymptomatic volunteers with atypical numbers of vertebrae. The spine surgeon confirmed that two volunteers had only four lumbar vertebrae, whereas the radiologist believed there were no four-lumbar vertebrae volunteers. In addition, differences between the surgeon and radiologist were seen in the results of the vertebral body count, even though they both used the same method see Table 1.
C cervical vertebrae, T thoracic vertebrae, L lumbar vertebrae. Differences were reviewed by the surgeon and radiologist, and a consensus was obtained in all cases. Twenty-eight 9. Seventeen 5. An LSTV was present in nearly all patients who had an atypical number i. In total, 5 1. The X-ray images of each group are shown in Fig. The patient demographic data are included in Table 2. The volunteers had a mean age of A previous study reported that approximately 10— However, we found no study of normal individuals having 11 thoracic vertebrae combined with 6 lumbar vertebrae.
This study was a cross-sectional analysis of the rate of presence of 11 thoracic vertebrae and 6 lumbar vertebrae among healthy subjects, as visualized on full-spine standing radiographs. We found that 9. Among all volunteers, 4. Thus, 5. Our findings are consistent with those of the previous studies [ 15 , 16 ]. However, the height and weight of the volunteers with 11 thoracic vertebrae and 5 lumbar vertebrae were significantly lower than those of the volunteers with a normal number of vertebrae.
We believe that a reduction in the number of thoracic vertebrae has a great effect on body length and body size. Studies on the spinal morphology and alignment are being reported with increasing frequency [ 1 — 9 ]. However, although these studies used various measures to reduce errors when measuring spinal parameters, such as the establishment of exclusion criteria, and performance of multiple measurements by various experts, many of them ignored the important question of whether spinal parameters are measured accurately when there is variation in the number of vertebrae among patients [ 1 — 9 ].
For example, Mizutani et al. Yokoyama et al. Although an intervertebral disc exists between the L6 vertebra and the inferior sacral vertebra, mobility between the L6 vertebra and sacrum may be restricted [ 17 ]. When measuring the thoracic parameters of 11 thoracic vertebrae individuals, replacing T12 with T11 is the first intuition. However, if both 11 thoracic vertebrae and L6 are present, and L6 did not originate in S1, the superfluous first lumbar vertebra may be the last thoracic vertebra lacking ribs.
In such cases, it seems appropriate to replace T12 with L1. A spinal alignment database specifically pertaining to cases with an atypical number of vertebrae should be established. We remain skeptical of the article comparing global spinal alignment and balance between patients with atypical and normal numbers of vertebrae [ 5 ].
Wrong-level surgery is a sensitive and serious event for both the patients and the spine surgeons. Certain factors, including atypical anatomy, have been considered responsible for wrong-site spine surgery. Based on an analysis of 65 spinal surgery lawsuits, Goodkin et al. An atypical number of vertebrae and the presence of LSTV may hamper accurate assessment of spinal anatomy. Approximately 5. During the last 10 years, only one wrong-level surgery was conducted at our spinal surgery center among more than surgeries.
Previous studies have also noted the role of LSTV in wrong-level discectomies. If 11 thoracic vertebrae are present, the ability to determine the surgical level before or during surgery based on cephalocaudal enumeration will be affected by changes in the thoracic vertebrae. Although researchers have proposed several lumbar localization methods for thoracolumbar surgery [ 12 , 19 ], Longo suggests that further strategies are needed to reduce the risk of wrong-level surgery [ 20 ].
Mody et al. In this study, there was a difference between the spine surgeon and radiologist in the ability to discriminate among vertebral variations, although the difference was not statistically significant. Considering the high 9. More conveniently, the surgeon can associate the preoperative findings with the intraoperative X-ray films.
To our knowledge, this is the first study of asymptomatic patients showing variation in the number of thoracic and lumbar vertebrae.
However, some weaknesses of the study should be acknowledged. Regardless of how carefully we examined these radiographs, there could be a certain amount of misdiagnosis. It must be clear to all readers of this article that the data provided above is just a bit closer to the truth. Second, we cannot be sure that the incidence of variations in the number of thoracic or lumbar vertebrae in our limited sample is representative of the rate of such variations among the general population of eastern China; this remains to be confirmed by other researchers.
Third, we did not include any patients with cervical ribs, 4 lumbar vertebrae, or 13 thoracic vertebrae. As expected, our selection criteria excluded these particular vertebrae variants. The rate of presence of cervical ribs varies from 0.
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