Vertebrae

The spine extends from the head to the sacrum, and in most people consists of 24 vertebrae.
The vertebral column can be divided into three segments:

Cervical
The first seven vertebrae, all in the neck. These are smaller and lightly built.
Thoracic
Twelve vertebrae, each articulating with the twelve pairs of ribs.
Lumbar
The lower five vertebrae, between the ribs and the sacrum. These have the largest vertebral bodies.
Spinal Deformity Study Group:
Radiographic Measurement Manual
Spinal Deformity Study Group:
Radiographic Measurement Manual
 Thoracal
• T1 is defined as the first vertebra with a pair of associated ribs.
• All vertebrae distal to T1 with associated ribs are defined as thoracic.
Usually there are 12 thoracic vertebrae.
• The most common variations are 11 or 13 thoracic segments.

Spinal Deformity Study Group:

Radiographic Measurement Manual
 Lumbar
• L1 will always be the vertebra immediately below the last thoracic
vertebra, that is the last vertebra with an associated pair of ribs.
• The lumbar spine typically has five vertebrae, but may occasionally
have four or six segments.
• It is not mandatory that the overall number of spinal segments be
conserved at 24 ( i.e., 7 cervical + 12 thoracic + 5 lumbar = 24). It is
possible that a patient may have 13 thoracic vertebrae and six lumbar
vertebrae. It is more common, however, that the number of spinal
segments are conserved.

Spinal Deformity Study Group:

Radiographic Measurement Manual
 Steps for labeling and measuring normal and
atypical vertebrae
1. Start at the first vertebra with ribs and call that T1.
2. Continue labeling vertebrae until the last one with ribs is identified (it
could be T11, 12, or 13).
3. If there are 11 definite ribs with 6 vertebrae below and it is not clear
if the 12th vertebra has a rib, call it T12 to maintain the 12 Thoracic
and 5 Lumbar numbering.
4. In all other cases, the first vertebra below the last thoracic vertebra
(last vertebra with ribs) is considered L1.
5. The L5 junction is reviewed for lumbarization or sacralization of the
transitional vertebra.
Spinal Deformity Study Group:
Radiographic Measurement Manual
https://www.imaios.com/en/e-Anatomy/Spine/Spine-standard-radiography
https://www.imaios.com/en/e-Anatomy/Spine/Spine-standard-radiography
https://www.imaios.com/en/e-Anatomy/Spine/Spine-standard-radiography
https://www.imaios.com/en/e-Anatomy/Spine/Spine-standard-radiography
https://www.imaios.com/en/e-Anatomy/Spine/Spine-standard-radiography
 Lumbosacral Transitional Vertebra (LSTV)

• LSTVs are congenital spinal anomalies defined as either sacralization

of the lowest lumbar segment or lumbarization of the most superior
sacral segment of the spine.
• STVs are common within the spine, and their association with low
back pain has been debated in the literature for nearly a century.
• LSTVs are common in the general population, with a reported
prevalence of 4%–30%.

Konin G, Walz D. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. American Journal of Neuroradiology. 2010;31(10):1778-1786.
 Lumbosacral Transitional Vertebra (LSTV)
• While LSTVs can be identified on all imaging modalities, they have
been classically described as being best imaged on Ferguson
radiographs (AP radiographs angled cranially at 30°).
• CT is the best imaging technique for characterization of LSTVs.
• Other morphologic characteristics of transitional vertebrae include
squaring of the upper sacral segment when it is lumbarized and
wedging of the lowest lumbar segment when it is sacralized.

Konin G, Walz D. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. American Journal of Neuroradiology. 2010;31(10):1778-1786.
Konin G, Walz D. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. American Journal of Neuroradiology. 2010;31(10):1778-1786.
 Classification
Castellvi et al described a radiographic classification system identifying 4 types of
LSTVs on the basis of morphologic characteristics:
• Type I includes unilateral (Ia) or bilateral (Ib) dysplastic transverse processes,
measuring at least 19 mm in width (craniocaudad dimension).
• Type II exhibits incomplete unilateral (IIa) or bilateral (IIb)
lumbarization/sacralization with an enlarged transverse process that has a
diarthrodial joint between itself and the sacrum.
• Type III LSTV describes unilateral (IIIa) or bilateral (IIIb) lumbarization/sacralization
with complete osseous fusion of the transverse process(es) to the sacrum.
• Type IV involves a unilateral type II transition with a type III on the contralateral
side 

Konin G, Walz D. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. American Journal of Neuroradiology. 2010;31(10):1778-1786.
 Castellvi classification

Konin G, Walz D. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. American Journal of Neuroradiology. 2010;31(10):1778-1786.
Spinal Deformity Study Group:
Radiographic Measurement Manual