On the Incidence of the Sacralized Transverse Process and Its Significance

Abstract

INTEREST in the sacralization of the transverse process of the fifth lumbar vertebra has manifested itself in a very extensive list of publications, the greater part being by French and Italian writers. It is evident that the problem of the sacralized transverse process has, in France, attracted a degree of attention seemingly out of proportion to its medical importance. One writer, Léri (1), caustically states that it has become the “mode,” which is reminiscent of our “sacro-iliac strain” of a few years ago. Painful sacralization has been designated “Bertolotti's syndrome” in Italy, following the publications on that subject of the writer of that name (2). In England, Holland (3) has published an excellent paper on this subject and states that there were no other British titles. Among other things, he reports that he encountered 10 cases in the course of a year. In this country, Goldthwait (4) and Adams (5) have written on sacralization. Moore (6), Bauman (7) and Rugh (8) have dealt with the operative results. Richard (9) published a splendid article on the diagnostic aspects in 1919 and no later writer has improved on his work. He found bone anomalies present in 90 per cent of patients with painful back, and of this number 60 per cent showed anomalies of the transverse process. Sutherland (10), in a paper on anomalies of the spine, reported 527 sacralizations in 12,000 radiographs, an incidence of 4.5 per cent, but did not supply clinical data. Sacralization has long attracted the attention of the anatomist and the morphologist. As Quain says, the subject is of interest not only in regard to the spine, but in relation to the whole problem of variations in general (11). Neither should its anthropological interest be overlooked. But its medical importance until recent times has been restricted to pelvic deformities and their obstetrical bearing—the high or low assimilation pelvis of the obstetrician (12). The anomaly cannot be discovered except by radiography and through radiography attention has been drawn to it because the anomaly is so frequent and its association with painful symptoms in the back so close, that the question of its incidence and significance deserves consideration. Albanese (13), after study of a very large amount of anatomical material, concludes that sacralization is atavistic. He found it in 4 per cent of Europeans and in 41.6 per cent of inferior races. Mauclaire and Flipo (14) found in anatomical material an incidence of 2 per cent in Europeans and of 40 per cent in lower races, the anomaly being extremely common in anthropoid apes. They quote Rossi as discovering the condition seven times in four hundred radiographs, and conclude that it is reversive.