Prevalence of Lumbosacral Transitional Vertebrae and Association of Castellví Types With Low Back Pain Severity and Disc Degeneration
Abstract
Background:
Lumbosacral transitional vertebrae (LSTV) represent frequent congenital anatomical variants; however, their pathogenetic role in low back pain (Bertolotti syndrome) remains controversial.
Objectives: To determine the prevalence of LSTV and evaluate its association with the frequency and severity of low back pain.
Materials and methods: We retrospectively evaluated radiographic and MRI images of the lumbosacral spine in 350 patients with chronic low back pain (study group) and 200 asymptomatic controls (control group). LSTV was classified according to the Castellvi system (types I–IV).
Results: The overall prevalence of LSTV in the study cohort was 18.2% (n = 100). LSTV was detected significantly more frequently in patients with low back pain than in asymptomatic controls (21.7% vs. 12.0%; p = 0.004). Castellvi types IIa and IIb (pseudoarthrosis between the enlarged transverse process and the sacrum) exhibited the strongest association with VAS pain intensity (OR = 2.85; 95% CI: 1.42–5.72; p = 0.003). Overlying L4–L5 disc degeneration was significantly more common in patients with Castellvi type II LSTV than in non-LSTV subjects (62.3% vs. 38.1%; p < 0.001).
Conclusions: Lumbosacral transitional vertebrae (specifically Castellvi type II) are strongly associated with low back pain and accelerated degeneration of adjacent intervertebral discs.
Keywords:
Transitional vertebra; LSTV; sacralization; lumbarization; low back pain; Castellvi classification.
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