UNASSIGNED: To evaluate the role of lumbar sacralization (LS) on the surgical outcomes of L4-L5 microdiscectomy.
UNASSIGNED: This prospective cohort study was conducted in a university referral hospital. The patients with L4-L5 disc herniation and eligible for microdiscectomy were enrolled and allocated in G1 (with LS) and G2 (no LS). After the L4-L5 microdiscectomy patients were followed, clinical and radiological parameters were collected to investigate the influence on the outcomes. Recurrence, low back outcome score (LBOS), and the Oswestry disability index (ODI) were defined as main outcomes.
UNASSIGNED: Two hundred and forty patients (n = 120, each), were reviewed in the final analysis. There was no difference between groups regarding baseline characteristics. Postoperative radicular and back pain was more severe in LS(P < 0.05). Univariate analysis showed recurrence was significantly higher in LS with a direct correlation with postoperative back pain persistence and low LBOS (p = 0.001). Age had a negative impact on G2 recurrence(p = 0.008). LS had a negative impact on LBOS and ODI scores. Postoperative radicular pain and higher lumbar lordosis were associated with a higher disability (ODI) index.
UNASSIGNED: L4-L5 microdiscectomy in patients with lumbar sacralization was associated with higher recurrence rates, worse ODI and LBOS scores, persistent postoperative axial back pain, and radicular pain. Postoperative axial back pain and poor LBOS results could effectively predict a higher recurrence rate following L4-L5 microdiscectomy in lumbar sacralization.

UNASSIGNED: Lumbosacral junction anomalies represent a rather frequent finding in patients with low back pain. Involved healthcare professionals should be familiar with these dysplasias, in order to achieve proper diagnosis and optimize clinical outcomes.
UNASSIGNED: Dysplastic alterations in lumbosacral junction represent a frequent finding in patients with low back pain. Lumbosacral transitional vertebra (LSTV), spina bifida occulta (SBO) and isthmic spondylolisthesis (IS) present recognized etiologies of low back pain. Herein, we present a rare case of concurrent presence of LSTV, SBO and IS in a middle-aged male individual who was presented with low back pain in our department. Considering the resistant to conservative treatment symptomatology in conjunction with clinical-radiologic presence of segmental instability, patient was subjected to uneventful minimally invasive lumbosacral fusion featuring complete recession of symptomatology directly postoperatively with no signs of recurrence until 6 months follow-up. To our best knowledge, coexistence of LSTV, IS and SBO in lumbosacral junction has never been described in contemporary literature. Whenever surgery is indicated, minimally invasive spinal fusion may be considered as a safe and effective alternative in these cases.

Pelvic incidence and lumbar lordosis have only normative values for spines comprising five lumbar and five sacral vertebrae. However, it is unclear how pelvic incidence and lumbar lordosis are affected by the common segmentation anomalies at the lumbo-sacral border leading to lumbosacral transitional vertebrae, including lumbarisations and sacralisations. In lumbosacral transitional vertebrae it is not trivial to identify the correct vertebral endplates to measure pelvic incidence and lumbar lordosis because ontogenetically the first sacral vertebra represents the first non-mobile sacral segment in lumbarisations, but the second segment in sacralisations. We therefore assessed pelvic incidence and lumbar lordosis with respect to both of these vertebral endplates. The type of segmentation anomaly was differentiated using spinal counts, spatial relationship with the iliac crest and morphological features. We found significant differences in pelvic incidence and lumbar lordosis between lumbarisations, sacralisations and the control group. The pelvic incidence in the sacralised group was mostly below the range of the lubarisation group and the control group when measured the traditional way at the first non-mobile segment (30.2°). However, the ranges of the sacralisation and lubarisation groups were completely encompassed by the control group when measured at the ontogenetically true first sacral vertebra. The mean pelvic incidence of the sacraliation group thus increased from 30.2° to 58.6°, and the mean pelvic incidence of the total sample increased from 45.6° to 51.2°, making it statistically indistinguishable from the control sample, whose pelvic incidence was 50.2°. Our results demonstrate that it is crucial to differentiate sacralisations from lumbarisation in order to assess the reference vertebra for pelvic incidence measurement. Due to their significant impact on spino-pelvic parameters, lumbosacral transitional vertebrae should be evaluated separately when examining pelvic incidence and lumbar lordosis.

UNASSIGNED: Bertolotti syndrome (BS) is defined as a congenital anomaly of the spine that includes sacralization of the lowest lumbar vertebra or lumbarization of the first sacral vertebra (i.e., lumbosacral transitional vertebra- LSTV) and the pain associated with this condition. The incidence of BS in adolescence is rare; we found only three such case reports of patients under the age of 18 in the literature, here will add a fourth.
UNASSIGNED: A 17-year-old female presented with a 2-month history of low back pain exacerbated by physical activity. Her neurological examination was normal, except for pain elicited when applying pressure over the sacroiliac joints bilaterally, and over the spinous process of the L5 vertebra. The computed tomography scan documented BS: (i.e., LSTV - Castellvi classification: Type IIa on the left side). She was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone.
UNASSIGNED: Here, we report a 17-year-old female who was symptomatic from BS and was successfully treated with NSAIDs.

A lumbosacral transitional vertebra (LSTV) has been reported to be prevalent among patients with hip dysplasia. The aims of this study were to determine the (1) prevalence of an LSTV in young patients presenting with hip pain and a group of asymptomatic volunteers, (2) effect of an LSTV on spinopelvic characteristics, and (3) presence of low back pain among patients with an LSTV.
UNASSIGNED: This cross-sectional study included 102 patients with hip pathology and 51 asymptomatic volunteers (mean age, 33.9 ± 7.3 years; mean body mass index, 26.0 ± 5.0 kg/m2; 57.5% female). Participants underwent radiographic assessment of the lumbar spine and pelvis in standing and deep-seated positions. LSTV occurrence was classified according to the Castellvi system. Spinopelvic characteristics included lumbar lordosis (including segmental lumbar angles), pelvic tilt, and hip flexion (pelvic-femoral angle). Differences between standing and deep-seated values were calculated. Low back pain was assessed using the Oswestry Disability Index.
UNASSIGNED: The prevalence of LSTV type ≥II was 8.5%, with no difference between patients and volunteers (p = 0.386). Individuals with an LSTV had a greater standing L1-L5 angle (mean, 51.6° ± 11.7° versus 38.9° ± 9.3°; p < 0.001). The overall spinal flexion (change in L1-S1 angle between the standing and deep-seated positions) in individuals with an LSTV was similar to that in individuals without an LSTV; restricted L5-S1 mobility was compensated for at L1-L2 (10.2° ± 5.8° in those with versus 8.4° ± 4.1° in those without an LSTV; p = 0.070). No significant difference in the presence of low back pain was found (p = 0.250).
UNASSIGNED: An LSTV was found in 8.5% of young adults, with no difference between patients with hip pathology and controls. Individuals with an LSTV have greater standing lumbar lordosis, with altered mechanics at the cephalad adjacent level, which may predispose these individuals to degenerative changes at this level.
UNASSIGNED: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

UNASSIGNED: A retrospective single-center study.
UNASSIGNED: The prevalence of the lumbosacral anomalies remains controversial. The existing classification to characterize these anomalies is more complex than necessary for clinical use.
UNASSIGNED: To assessment of the prevalence of lumbosacral transitional vertebra (LSTV) in patients with low back pain and the development of clinically relevant classification to describe these anomalies.
UNASSIGNED: During the period from 2007 to 2017, all cases of LSTV were preoperatively verified, and classified according to Castellvi, as well as O\'Driscoll. We then developed modifications of those classifications that are simpler, easier to remember, and clinically relevant. At the surgical level, this was assessed intervertebral disc and facet joint degeneration.
UNASSIGNED: The prevalence of the LSTV was 8.1% (389/4816). The most common L5 transverse process anomaly type was fused, unilaterally or bilaterally (48%), to the sacrum and were O\'Driscoll\'s III (40.1%) and IV (35.8%). The most common type of S1-2 disc was a lumbarized disc (75.9%), where the disc\'s anterior-posterior diameter was equal to the L5-S1 disc diameter. In most cases, neurological compression symptoms (85.5%) were verified to be due to spinal stenosis (41.5%) or herniated disc (39.5%). In the majority of patients without neural compression, the clinical symptoms were due to mechanical back pain (58.8%).
UNASSIGNED: LSTV is a fairly common pathology of the lumbosacral junction, occurring in 8.1% of the patients in our series (389 out of 4,816 cases). The most common types were Castellvi\'s type IIA (30.9%) and IIIA (34.9%) and were O\'Driscoll\'s III (40.1%) and IV (35.8%).

BACKGROUND: Castellvi type III and IV lumbosacral transitional vertebrae (LSTVs) are fused to the sacrum. In these cases, the pelvic incidence (PI) and pelvic tilt (PT) may vary according to the selected \"S1.\" This study aimed to determine the optimum vertebral level of these LSTVs when measuring PI and PT.
METHODS: PI and PT were measured twice in 56 patients with type III and IV LSTVs with a balanced spine, with LSTV considered as the lowest lumbar vertebra (LLV) or S1. PI and PT measured with LSTV as LLV were denoted as LLV_PI and LLV_PT, and those measured as S1 were denoted as S_PI and S_PT. Reference ranges (mean -2 SD to +2 SD) of PI and PT were derived from 183 non-LSTV patients with a balanced spine as 35.5° to 68.8° (PI) and 2.5° to 29.6° (PT). If S_PI, S_PT, or both were below the reference range, the LSTV was interpreted as LLV. If LLV_PI, LLV_PT, or both were above the reference range, it was interpreted as S1. If all parameters were within the respective reference range, it was interpreted as an intermediate type.
RESULTS: The optimum vertebral level of LSTV was S1 (n = 29, 51.8%), most frequently due to high LLV_PT (35.4°±4.7), followed by LLV (n = 14, 25%) due to low S_PI (31.5°±5.2) and intermediate type (n = 13, 23.2%).
CONCLUSIONS: If PI is too small or PT is too large to represent the actual sagittal alignment in patients with Castellvi type III and IV LSTVs, the selected S1 should be reconsidered.
CONCLUSIONS: PI and PT measurements can be used to determine whether the optimum vertebral level of Castellvi type III and IV LSTV should be considered LLV or S1.
METHODS:

Common and minor birth defects, such as spina bifida occulta (SBO) and lumbosacral transitional vertebra (LSTV), are largely asymptomatic and overlooked. However, it is important for clinicians to consider their potential impacts on spinal stability. Neuromuscular scoliosis (NMS) is an abnormal lateral curvature of the spine that affects children with pre-existing neuromuscular conditions that are often complex to manage. The purpose of this case report is to describe the association of dual lumbosacral anomalies with complicated NMS. A 12-year-old boy was brought to the chiropractor by his mother for a consultation and possible care for the boy\'s back pain, progressive scoliosis, and long-standing walking abnormality that worsened quickly in the past 12 months. His mother stated that the patient walked on the balls of his left foot instead of putting weight on the heel ever since he started learning to walk. He had visited several pediatricians and neurologists since childhood. No one had been able to solve his problems. Radiographs showed right thoracolumbar curve of Cobb angle 20°, left pelvic obliquity, a cleft in the L5 and S1, and articulation of the transverse processes of L5 with the bilateral sacral alae. The patient was diagnosed with NMS and functional leg length discrepancy attributed to SBO and a LSTV at L5 level. Multimodal chiropractic care and foot orthotics were used. After 18 months of interventions, normal spinal curve, heel-to-toe gait, and posture balance were retrieved successfully. To date, few reports have been published on the impacts of SBO along with LSTV upon the lumbosacral spine. This article will allow a better understanding of the potential impacts of these birth defects and considerable consequences they would have on the growing spine and, therefore, may help to alleviate their impacts.

Lower back pain is a common symptom, which is managed by various specialties including neurology, orthopedics, general medicine, and rheumatology. Lumbosacral transitional vertebra (LSTV) is an important cause of back pain, about which many clinicians are unfamiliar. It is a congenital malformation of the spine, which results from abnormal fusion of the sacrum with the vertebra above, to a variable extent. An extra joint is formed between the ala of sacrum and the elongated transverse process of the vertebra above on one or both sides. It leads to altered rotational movement of the lower spine, which gives rise to back pain. Spina bifida occulta (SBO) is another congenital malformation of the spine, which is detected incidentally because it does not cause any symptoms. We observed frequent co-existence of SBO and LSTV in patients attending our rheumatology clinic for lower back pain.

Bertolotti Syndrome is a diagnosis given to patients with lower back pain arising from a lumbosacral transitional vertebra (LSTV). These patients can experience symptomatology similar to common degenerative diseases of the spine, making Bertolotti Syndrome difficult to diagnose with clinical presentation alone. Castellvi classified the LSTV seen in this condition and specifically in types IIa and IIb, a \"pseudoarticulation\" is present between the fifth lumbar transverse process and the sacral ala, resulting in a semi-mobile joint with cartilaginous surfaces.Treatment outcomes for Bertolotti Syndrome are poorly understood but can involve diagnostic and therapeutic injections and ultimately surgical resection of the pseudoarticulation (pseudoarthrectomy) or fusion of surrounding segments.
To examine spine and regional injection patterns and clinical outcomes for patients with diagnosed and undiagnosed Bertolotti Syndrome.
Retrospective observational cohort study of patients seen at a single institution\'s tertiary spine center over a 10-year period.
Cohort consisted of 67 patients with an identified or unidentified LSTV who were provided injections or surgery for symptoms related to their chronic low back pain and radiculopathy.
Self-reported clinical improvement following injections and pseudoarthrectomy.
Patient charts were reviewed. Identification of a type II LSTV was confirmed through provider notes and imaging. Variables collected included demographics, injection history and outcomes, and surgical history for those who underwent pseudoarthrectomy.
A total of 22 out of 67 patients (33%) had an LSTV that was not identified by their provider. Diagnosed patients underwent fewer injections for their symptoms than those whose LSTV was never previously identified (p = 0.031). Only those diagnosed received an injection at the LSTV pseudoarticulation, which demonstrated significant symptomatic improvement at immediate follow up compared to all other injection types (p = 0.002). Patients who responded well to pseudoarticulation injections were offered a pseudoarthrectomy, which was more likely to result in symptom relief at most recent follow up than patients who underwent further injections without surgery (p < 0.001).
Undiagnosed patients are subject to a higher quantity of injections at locations less likely to provide relief than pseudoarticulation injections. These patients in turn cannot be offered a pseudoarthrectomy which can result in significant relief compared to continued injections alone. Proper and timely identification of an LSTV dramatically alters the clinical course of these patients as they can only be offered treatment directed towards the LSTV once it is identified.