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Transitional vertebrae are a fairly common spinal deformity

PainSci » bibliography » Apazidis et al 2011
Tags: back pain, etiology, biology, surgery, biomechanics, pain problems, spine, pro, treatment

Three articles on PainSci cite Apazidis 2011: 1. The Complete Guide to Low Back Pain2. Your Back Is Not Out of Alignment3. You Might Just Be Weird

PainSci commentary on Apazidis 2011: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

“Transitional vertebra” is a fairly common spinal deformity, in which the lowest vertebrae of the spine, the fifth lumbar vertebra, is partially fused to the top of sacrum. This odd hybrid bone is not a proper lumbar vertebra, and certainly not a sacral segment either — thus, it is a “transitional” vertebra.

Do people with this deformity get more back pain? In 2011, Apazidis et al. studied how common these transitional vertebrae are, and whether or not they correlate with low back pain. They found that this common spinal variation is not much more common in people with back pain, and possibly no more common at all:

Although LSTV’s role in low back pain remains controversial, our study has shown that, when the same criteria are used for classification, prevalence among the general population and symptomatic patients may be similar.

As always, this kind of finding is at odds with an entire industry of therapy based on trying to fix subtle alleged biomechanical problems because they allegedly exist and supposedly hurt. And yet here we have a vertebral birth defect that is found in pain-free people about as often as it is found in cases of back pain. Something is wrong with this picture. These results give us yet more evidence that spinal structure is probably not a major factor in back pain. Even if it’s wrong (and there is conflicting evidence, see Sekharappa 2014), it’s extremely unlikely to drive as much pain as we thought.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND CONTEXT: Lumbosacral transitional vertebrae (LSTVs) are a congenital vertebral anomaly of the L5-S1 junction in the spine. This alteration may contribute to incorrect identification of a vertebral segment, leading to wrong-level spine surgery and poor correlation with clinical symptoms. Although several studies describe the occurrence of this anomaly in back pain populations, investigation of the prevalence in the American general population is lacking.

PURPOSE: To establish the prevalence rates for LSTVs in the general population.

STUDY DESIGN: Retrospective review.

PATIENT SAMPLE: Consecutive kidney-urinary bladder (KUB) radiographs of subjects from the past 2 years (2008-2009).

OUTCOME MEASURES: Clinical demographics, number of lumbar vertebrae, L5-S1 transverse process (TP) height, and rib length.

METHODS: Consecutive adult KUB studies of adult subjects were queried with clear visibility of the last rib's vertebral body articulation, all lumbar TPs, and complete sacral wings. Exclusion criteria consisted of any radiologic evidence of previous lumbosacral surgery that would obstruct our measurements. A total of 1,100 abdominal films were reviewed, and 211 were identified as being adequate for the measurement of the desired parameters.

RESULTS: Two hundred eleven subjects were identified as eligible for the study, and 75 (35.6%) were classified as positive for a transitional lumbosacral vertebra. The most common anatomical variant was the Castellvi Type IA (14.7%). The average age at the time of the KUB study was 59.8 years (18-95 years). One hundred ninety-seven subjects (93.4%) presented five lumbar (nonribbed) vertebrae, and only 14 (6.6%) had six lumbar vertebrae.

CONCLUSIONS: The significance of lumbosacral transitional level changes to the establishment of pain, degenerative changes, stenosis, and disc disease have been well documented in symptomatic patients. Although LSTV's role in low back pain remains controversial, our study has shown that, when the same criteria are used for classification, prevalence among the general population and symptomatic patients may be similar.

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