Transitional Vertebrae and Lower Back Pain: A Case Series

Introduction: Lumbosacral transitional vertebrae (LSTV) are anatomical variations in the spine where the lowest vertebra is abnormally connected to the sacrum. LSTV can present when the superior portion of the sacrum (S1) separates from the sacrum, creating an extra lumbar vertebra (L6), or in conjunction with Bertolotti syndrome, characterized by the transverse process of L5 articulating with the sacrum. LSTV can contribute to biomechanical changes in the spine, leading to various pain presentations. Although LSTV can be found in up to 40% of the population, there is a paucity of research on its clinical implications, especially regarding pain and function in adolescents and preadolescents. This case series aims to explore the clinical characteristics, treatment, and outcomes in patients with LSTV who present with low back pain, ultimately providing insight into its management and prognosis.

Methods: Researchers analyzed lumbar spine X-rays from the past five months at a pediatric orthopedic outpatient clinic in Northern New Jersey. They evaluated 82 patients who complained of low back pain, collecting data on patient demographics, clinical presentation, radiographic findings, and treatments. Pain assessment relied on patient reports and physical exam findings.

Results: Among the 82 patients with low back pain, six non-pediatric patients were excluded. Of the remaining 76 patients, 12 were diagnosed with LSTV (15.8%) through clinical evaluations and X-ray confirmation, including 5 males and 7 females with an average age of 11.1 years.

Conclusion : This study suggests that LSTV can significantly contribute to low back pain. Despite the limited sample size, findings are consistent with existing literature regarding the incidence and gender similarities in LSTV. Notably, 8 out of 12 patients with LSTV presented with chronic back pain, indicating a higher risk for muscle strains and long-term injuries. A prospective longitudinal cohort study could further elucidate the clinical manifestations and follow-up rates in LSTV patients.