Diagnostic Precision in Lumbar Radiculopathy: Impact of Transitional Vertebrae on Treatment Level Selection and Outcomes

Background: In patients with lumbosacral transitional vertebrae, discrepancies indetermining the correct vertebral level of lumboradicular pain occur. This study evaluates the consequences of the real-world diagnostic process and subsequent treatment differences due to misidentified levels. Methods: This retrospective analysis used prospectively collected data on involved spinal levels (February 2016 to October 2022) reported in the referrals, MRI- and treatment reports. Variables analyzed included the number of referrals, consultations, invasive treatments, duration of treatment, radiographs, operations, and hospitalization. Independent clinical researchers conducted vertebral counting, transitional vertebra classification, and wrong level determination using standard methods. Results: Of a total of 4184 patients assessed, 214 included patients (5.1%) with lumbosacral transitional vertebrae were divided into 3 groups: Correct level determination (72), wrong level determination (36) andambiguous level diagnosis (106).Theambiguous levelgroup had more consultations, interventional treatments, radiographic diagnostics, longer treatment duration and more referrals to other hospitals (P<.04) at the pain management department and significantly less consultations of other specialisms (P < .01–.02) compared to the other groups due to uncertain level diagnosis. Discrepancies between reported MRI- and treatment levels in the records increased the chance for wrong level treatment (P<.001). Conclusion: In patients with lumbosacral transitional vertebrae and lumboradicular pain, discrepancies between referral, MRI, and treatment levels are common, leading to uncertain diagnoses and treatment due to incorrect leveldetermination. Interdisciplinary consultation to reach consensus on the most appropriate spinal level for treatment and clear spine images may prevent such discrepancies. Amulticentre study with a larger patient sample is strongly recommended.