Transitional vertebrae (TV) may be one of the risk factors for lumbar disc herniation. It is not clear, however, whether the presence of TV can affect the development of nerve-root symptoms. Our aim was to clarify this relationship. A total of 501 patients with lumbar degenerative disease and nerve-root symptoms was studied in respect of their level and the presence of TV. As a control group, 508 patients without low back pain or nerve-root symptoms were studied to establish the incidence of TV. In patients with disc herniation, the incidence was statistically higher and the mean age lower in patients with TV than in those without. In most patients, the symptomatic disc level was just above the TV. Similarly, in those with stenosis of the spinal canal without spondylolisthesis, the symptomatic disc level was most commonly just above the TV.

There are many difficulties associated with the localisation of the symptomatic segment in patients presenting with cervicobrachial pain with no evidence of impaired conduction in the nerve root. Ancillary radiological investigations such as myelography, epidural phlebography, and epidural myelograms are of unreliable diagnostic value. However, discography can be of value if the technique described here is used. Infiltration of the cervical nerve root with local anaesthetic has also proved useful in the localisation of the symptomatic segment. The techniques used in cervical discography and infiltration of the nerve root are described and their reliability is assessed.

A case of the Jansen type of metaphysial dysostosis, followed for fifteen years from childhood to the age of nineteen, is reported. Radiographs taken at five years revealed the characteristic metaphysial changes in all the tubular bones, especially those of the hands and feet. The acetabular and glenoid areas, the costochondral junctions and the sternal ends of the clavicles were also involved. Radiographs taken at nineteen years, however, showed only marked deformities, which shows that the involvement of the metaphyses can regress by the end of growth. Biopsy of the lower end of radius at the age of twelve revealed changes in the growth plate or physis, especially in the zone of resting cartilage. This finding suggests that cellular function in this zone is disturbed by some unknown mechanism. Hence, the term physial dysostosis may be more accurate than metaphysial dysostosis.