# Prevalence, diagnosis, and clinical significance of lumbosacral transitional vertebrae: A systematic review and narrative analysis

## TL;DR

This paper reviews how common lumbosacral transitional vertebrae (LSTV) are, how they are diagnosed, and their impact on back pain and surgery.

## Contribution

A systematic review and narrative analysis of LSTV's prevalence, diagnosis, and clinical implications.

## Key findings

- LSTV prevalence ranges from 4.5% to 35.6% and is linked to low back pain and disc herniation.
- LSTV complicates surgery due to anatomical and vascular changes.
- LSTV affects fusion level choices and outcomes in Adolescent Idiopathic Scoliosis patients.

## Abstract

Lumbosacral Transitional Vertebrae (LSTV) are congenital anomalies at the L5-S1 segment, involving sacralization of the lowest lumbar vertebra or lumbarization of the highest sacral segment. Despite their clinical importance, a comprehensive systematic review addressing the prevalence, diagnosis, and clinical significance of LSTV remains limited.

This study aims to systematically review and synthesize current evidence regarding the prevalence, diagnostic methods, and clinical significance of LSTV.

An extensive literature search was undertaken across PubMed, Embase, and Medline databases to identify studies pertinent to the prevalence, diagnostic criteria, and clinical outcomes related to LSTV. All studies that satisfied our inclusion and exclusion criteria were methodically analyzed and included in this systematic review.

The mean prevalence of LSTV is 15.3 %, ranging from 4.5 % to 35.6 %, with higher occurrence in patients presenting with low back pain, disc herniation, and Adolescent Idiopathic Scoliosis (AIS). LSTV is diagnosed through imaging techniques such as X-ray, CT, and MRI, while symptomatic LSTV and Far-Out Syndrome (FOS) require clinical assessment, imaging, and diagnostic injections. LSTV is associated with an increased risk of nerve root compression, disc herniation, altered spinal pelvic parameters, and surgical complications including screw misplacement and vascular injury.

Given LSTV's prevalence, surgical planning, including segment election and precise measurements, must account for LSTV's presence and its impact on disease progression. More research with larger samples and longer follow-ups is needed to elucidate these clinical implications and enhance therapeutic strategies.

•LSTV is closely linked to low back pain and disc herniation.•LSTV complicates surgery due to anatomical and vascular changes.•LSTV affects fusion level choice and outcomes in AIS patients.

LSTV is closely linked to low back pain and disc herniation.

LSTV complicates surgery due to anatomical and vascular changes.

LSTV affects fusion level choice and outcomes in AIS patients.