1. Case of the Week 104
39 year old male presented to Serafin Leemann, DC (Zurich) with chronic low back pain.

2. 1. Identify three abnormalities. 2. Categorize these abnormalities. 3
1. Identify three abnormalities Categorize these abnormalities What is the clinical significance of each?

3. Answers Three Abnormalities
A. There are 4 lumbar vertebrae with a transitional lumbosacral vertebra (TLSV) (L5 or S1)
A knife clasp deformity is present at the transitional lumbosacral junction with an elongated SP of the transitional segment and a wide superior sacral hiatus (spina bifida occulta) below.
Both proximal femurs have the ‘pistol grip’ deformity indicating femoral acetabular impingement (FAI).
Category of each
All three of these abnormalities are in the Congenital anomaly category.
Clinical significance
TLSV: Early and more severe degenerative disc disease at the motion segment above (as is seen here). However, these people do not have greater pain or disability compared to low back pain patients who do not have a TLSV.
Knife clasp deformity: No significance usually. Some patients have low back pain or shooting leg pain with hyperextension.
FAI: Predisposes to early hip arthrosis.