Transversosacral Neoarthrosis

Lumbosacral transitional anomaly is a frequent finding on plain films. In some individuals, it is associated with a neoarthrosis between the transverse process of the lower lumbar vertebrae and the homolateral sacral or, less commonly, iliac wings. The neoarthrosis is frequently unilateral. In a few cases, pain may be clinically suspected to originate in the neoarthrosis. In these uncommon cases, selective injection of a local anesthetic and steroid into the neoarthrosis may be of diagnostic and therapeutic interest. Prior to performing the injection, it is wise to rule out

FIGURE 16 Instability in a degenerative pubic symphysis with abnormal (A) vertical displacement of each pubic bone according to left (G, A) or right (D, B) unipodal standing of the patient. Note the vacuum phenomenon within the pubic joint (A).

FIGURE 17 Needle placement into the pubic symphysis.

FIGURE 19 Anteroposterior arthrographic view of the pubic symphysis with a meniscus-like lucency (arrowheads) at the distal end of the joint cavity.

FIGURE 21 Opacified synovial pouch in a transversosacral neoarthrosis.

a simple radiographic superimposition of the transverse process on the sacral wing. In this case, the space between these bones would increase on additional views with appropriate X-ray beam inclination. Selective injection is performed through a posterior approach with the patient prone. The needle is inserted along an oblique direction optimally determined by the X-ray beam orientation that best delineates the neoarthrosis joint space (Fig. 20). Contrast injection may disclose a true synovial pouch surrounding the neoarthrosis (Fig. 21) (14).

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Dealing With Back Pain

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