Page mackup-Final.qxd Case report A forensic case of sacralization of the sixth lumbar vertebra in skeletal remains. Tanaka N1, Kinoshita H2, Jamal M3, Tsutsui K4, Motomura H5, Ameno K6 Abstract Lumbosacral transitional vertebrae (LSTVs) are a common congenital anomaly of the spine. In the pres- ent case, we observed LSTVs in the excessive (sixth lumbar) vertebra. In forensic practice, this anom- aly may be useful for personal identification of skeletal remains. Key Words: lumbosacral transitional vertebrae (LSTVs), skeletal remains, personal identification Introduction Personal identification is an essential subject in forensic medicine [1,2]. Morphological character- istics such as healed fractures, bone disease, con- genital defects and prosthesis provide useful infor- mation for personal identification in case of skele- tal remains1-6. Here we describe lumbosacral tran- sitional vertebrae (LSTVs), a congenital anomaly in the part of spine7, in relation to forensic skele- tal remains. Case History: Almost completely skeletonized human remains were found in a house, where an aged person had lived alone. Anthropological findings led us to determine that the deceased was a male between 60 to 80 years of age. The stature of the victim, cal- culated from the length of the femoral bones, was approximately 160-165cm, and the postmortem interval was estimated at approximately 2-4 years. No dental work, healed fractures, surgical inter- vention or recent injuries were recognized. The skeleton had extra lumbar vertebrae and sacraliza- tion of a sixth lumbar vertebra (Type IIB) was observed in the spine as a characteristic finding (Figure 1). Figure 1. Anterior (a) and posterior (b) views of the sacralization of the sixth lumbar vertebra in the present case. Subsequent DNA examination using AmpFlSTR® Identifiler® PCR Amplification Kit (Applied Biosystems, USA) identified the remains as the resident of this house. His age was within the esti- 1. Naoko Tanaka, Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750- 1, Miki, Kita, Kagawa, 761-0793, Japan. 2. Hiroshi Kinoshita, Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kita, Kagawa, 761-0793, Japan. 3. Mostofa Jamal, Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750- 1, Miki, Kita, Kagawa, 761-0793, Japan. 4. Kunihiko Tsutsui, Health Sciences, School of Nursing, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kita, Kagawa, 761-0793, Japan. 5. Hiroyuki Motomura, Forensic Science Laboratory, Hyogo Prefectural Police Headquarters, 4-1, Shimoyamate-dori 5-chome, Chuo-ku, Kobe, 650-8510, Japan. 6. Kiyoshi Ameno, Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750- 1, Miki, Kita, Kagawa, 761-0793, Japan. Corresponds to: Dr. H. Kinoshita, Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kita, Kagawa, 761-0793, Japan. E-mail: kinochin@med.kagawa-u.ac.jp Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13 224 mated range. Discussion Personal identification was performed by DNA typing in the present case. LSTVs are common congenital anomalies, and are defined as either sacralization of the lowest lumbar segment or lum- barization of most superior sacral segment of the spine 7 . Four types of LSTVs have been classified on the basis of morphological characteristics 8 . The frequency of occurrence of LSTVs varies in differ- ent human population groups, and it observed in 4- 24% of the general population 9 and in 15-18.1% of the Japanese population 10,11 . However, as the fre- quency of conversion of LSTVs into an excessive vertebra is 1.6% 12 , its characteristic findings may be useful for personal identification. It has been previously reported that low back pain associated with LSTVs is called Bertolotti’s syn- drome 13 . Although the relationship between LSTVs and low back pain remains controversial 14 , it has been reported that the incident of LSTVs in patient with low back pain is higher than that of the gen- eral population 9 . The person who has low back pain seems to seek medical examination, and they may have a higher opportunity to take X-ray films of the spinal region 15 . Comparisons of radiological morphological fea- tures between antemortem and postmortem X-ray films have been performed for personal identifica- tion in case of skeletal remains 16-20 . The morpholog- ical characteristic findings of spinal region may also provide useful information, if antemortem lumbosacral X-ray films was available in the pres- ent case. References 1. Knight B. Forensic Pathology. 2nd Edition. London: Arnold, 1996; 95-132. PMid:9414393 2. Jackson ARW, Jackson JM. Forensic Science. Essex: Pearson Education Limited 2004; 339- 349. 3. Ohshima T, Maeda H, Takayasu T, Zhu B, Lin Z, Nishigami J, Nagano T. Three cases of per- sonal identification on cadavers with advanced postmortem changes. Res Pract Forens Med 1991; 34: 299-305. 4. Aoki Y, Nata M, Hashiyada M, Saigusa K, Nakayama Y. Five cases of positive identifica- tion by means of implanted medical equipment. Res Pract Forens Med 1998; 41: 193-198. 5. Kinoshita H, Motomura H, Kasuda S, Nishiguchi M, Matsui K, Takahashi M, Ouchi H, Minami T, Yamamura T, Otsu N, Yoshida S, Adachi N, Ohta T, Hishida S. Positive iden- tification facilitated by implanted metallic plate and screws. Soud Lek 2009; 54: 16. PMid:19534396 6. Kinoshita H, Tanaka N, Ohi T, Jamal M, Ohkubo E, Ameno K. Prior surgical interven- tion of the bone; useful finding for the exami- nation of the skeletal remains. Bangladesh J Med Sci 2010; 9: 93-94. 7. Konin GP, Walz DM. Lumbosacral transition- al vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol 2010; 10: 1778-1786.http://dx.doi.org/ 10.3174/ajnr.A2036PMid:20203111 8. Castellvi AE, Goldstein LA, Chan DPK. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine 1984; 9: 493-495.http://dx.doi. o r g / 1 0 . 1 0 9 7 / 0 0 0 0 7 6 3 2 - 1 9 8 4 0 7 0 0 0 - 00014PMid:6495013 9. Delport EG, Cucuzzella TR, Kim N, Marley J, Pruitt C, Delport AG. Lumbosacral transition- al vertebrae: incidence in a consecutive patient series. Pain Physician 2006; 9: 53-56. PMid:16700281 10. Sato T, Akita K. (ed) Anatomic variations in Japanese. Tokyo: University of Tokyo Press 2000; 8. 11. Amako T. (ed) Jinnaka's Textbook of Orthopedic Surgery (20th eds). Tokyo: Nanzando 1978; 603-605. Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13 225 12. Takeuchi S. A study on the number of the Japanese vertebrae. Tokyo Jikeikai Medical Journal 1980; 95: 584-597. 13. Quinlan JF, Duke D, Eustace S. Bertolotti's syndrome. A cause of back pain in young peo- ple. J Bone Joint Surg Br 2006; 88: 1183-1186. h t t p : / / d x . d o i . o r g / 1 0 . 1 3 0 2 / 0 3 0 1 - 620X.88B9.17211PMid:16943469 14. Apazidis A, Ricart PA, Diefenbach CM, Spivak JM. The prevalence of transitional ver- tebrae in the lumbar spine. Spine J 2011; 11: 858-862.http://dx.doi.org/10.1016/j.spi- nee.2011.08.005PMid:21951610 15. Kanchan T, Shetty M, Nagesh KR, Menezes RG. Lumbosacral transitional vertebra: clinical and forensic implications. Singapore Med J 2009; 50: e85-e87.PMid:19296021 16. Ikeda N, Umetsu K, Harada A, Suzuki T. Radiologic identification of human skeletal remains: a acse report. Nihon Hoigaku Zasshi 1987; 41: 270-273.PMid:3682300 17. Owsley DW, Mann RW. Positive personal identity of human skeletonized remains using abdominal and pelvic radiographs. J Forensic Sci 1992; 37: 332-336.PMid:1545209 18. Gunji H, Hiraiwa K. Radiographic identifica- tion of unknown human remains with a bone island in the sacrum. Res Pract Forens Med 1992; 35: 297-300. 19. Sakaihara M, Terazawa K. A case of positive personal identity of skeletonized remains using lumbar radiograph. Hokkaido Igaku Zasshi 2002; 77: 157-160. PMid:11968851 20. Kahana T, Goldin L, Hiss J. Personal identifi- cation based on radiographic vertebral features. Am J Forensic Med Pathol 2002; 23: 36-41. h t t p : / / d x . d o i . o r g / 1 0 . 1 0 9 7 / 0 0 0 0 0 4 3 3 - 200203000-00007 PMid:11953491 N Tanaka, H Kinoshita, M Jamal, K Tsutsui, H Motomura, K Ameno 226