Lumbalisation – Causes, Symptoms and Treatment
Lumbalisation is a congenital spinal variant in which the first sacral vertebra (S1) takes on the form of a lumbar vertebra, resulting in six instead of five lumbar vertebrae.
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Lumbalisation is a congenital spinal variant in which the first sacral vertebra (S1) takes on the form of a lumbar vertebra, resulting in six instead of five lumbar vertebrae.
What Is Lumbalisation?
Lumbalisation (also spelled lumbalization or lumbarization) is a congenital anatomical variant of the spine. In this condition, the first segment of the sacrum (S1) fails to fully fuse with the rest of the sacrum and instead resembles a lumbar vertebra in both shape and mobility. This results in an apparent six lumbar vertebrae instead of the usual five. Lumbalisation belongs to a group of spinal anomalies known as lumbosacral transitional vertebrae (LSTV) and is the counterpart to sacralization, in which the fifth lumbar vertebra fuses with the sacrum.
Causes
Lumbalisation develops during embryonic development and is caused by abnormal segmentation of the spine. The exact causes are not fully understood, but genetic factors are suspected. The anomaly occurs sporadically and is not caused by external influences after birth. Lumbosacral transitional vertebrae occur in approximately 4–8% of the general population.
Symptoms
Many individuals with lumbalisation experience no symptoms and only learn of the condition incidentally during imaging studies. However, some people develop chronic or recurrent lower back pain, particularly at the lumbosacral junction. Common symptoms may include:
- Deep lower back pain (lumbago)
- Pain radiating into the buttocks or legs (similar to sciatica)
- Reduced mobility in the lower spine
- Premature degeneration of adjacent intervertebral discs and facet joints
Symptoms often arise due to altered biomechanics and asymmetric loading of the spine caused by the anatomical variation.
Diagnosis
Lumbalisation is typically diagnosed through imaging studies. The most important diagnostic methods include:
- X-ray of the lumbar spine and pelvis: Shows the number of lumbar vertebrae and the morphology of the sacrum.
- Magnetic resonance imaging (MRI): Provides detailed assessment of intervertebral discs, nerve structures, and soft tissues.
- Computed tomography (CT): Can be used for more precise bone visualization in unclear cases.
The Castellvi classification is commonly used to categorize lumbosacral transitional vertebrae into different types, enabling standardized description and communication among clinicians.
Treatment
A curative treatment for lumbalisation is not possible, as it is a congenital structural variant. Therapy is directed at managing existing symptoms.
Conservative Treatment
- Physiotherapy to strengthen core and back muscles and improve spinal mobility
- Pain management using anti-inflammatory medications (e.g., NSAIDs such as ibuprofen or diclofenac)
- Manual therapy and osteopathy to relieve muscle tension
- Heat and cold applications for pain relief
- Ergonomic adjustments at the workplace and modifications to daily activities
Interventional and Surgical Treatment
For persistent, treatment-resistant symptoms, interventional approaches such as infiltrations (targeted injections of analgesics or corticosteroids) may occasionally be considered. Surgical procedures (e.g., spinal fusion) are reserved for rare cases involving severe structural damage.
Prognosis
The prognosis for lumbalisation is generally favorable. Many individuals remain asymptomatic or can manage their symptoms effectively through conservative measures. Regular physical activity, a strong back musculature, and avoidance of excessive strain are key factors in maintaining long-term quality of life.
References
- Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine, 1984;9(5):493-495.
- Netter FH. Atlas of Human Anatomy. Elsevier, 7th edition, 2019.
- Farshad-Amacker NA, Farshad M, Winklehner A, Andreisek G. MR imaging of spine abnormalities. European Journal of Radiology, 2015;84(5):799-805.
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