LUMBOSACRAL TRANSITIONAL VERTEBRAE AS A RISK FACTOR FOR LOW BACK PAIN: A META-ANALYSIS

Background Lumbosacral transitional vertebrae (LSTV) is a congenital spine anomaly in which the enlarged transverse process of the fifth lumbar vertebrae can fuse with the first sacral segment forming sacralisation or lumbarisation. Low back pain (LBP) has the highest prevalence globally among musculoskeletal conditions and is the leading cause of disability worldwide. Various authors tried to investigate the relationship between LSTV and LBP in their local populations with different results but the correlation remained unclear. Aim of this study was to unambiguously determine if LSTV can independently cause pain of the lower back. Methodology Two databases (Pubmed and Embase) were searched for clinical-control studies in which authors analyzed prevalence of LSTV in both control group (without low back pain) and in a study group (with low back pain). Search terms such as: “lumbosacral transitional vertebrae”, “sacralisation”, “lumbarisation”, ”LSTV”, “Bertolotti syndrome”, “lumbosacral transitional segment” were implemented to find eligible articles which resulted in screening 2152 records by 3 independent researchers. Only studies where patients had non-specific low back pain with no underlying pathology were included. Pooled odds ratio was calculated using Comprehensive meta-analysis v4 programme under random effects model. Main results Our meta-analysis included 12 studies with 9910 patients. Pooled odds ratio turned out to be 1.35 (95%CI 1.15-1.58) which means that existence of LSTV significantly increases the chances of low back pain. Additional data shows prevalence of LSTV in symptomatic population at 18.9% (95%CI=0.15-0.23) while in asymptomatic population at 13.1% (95%CI=0.11-0.15) which confirms the correlation. Conclusions Our study is the first to unequivocally show an association between LSTV and LBP globally. LSTV is an independent and significant risk factor for lower back pain. When examining a patient suffering from low back pain, it is important to keep lumbosacral transitional vertebrae in mind as a potential separate cause of pain, especially when there is no other apparent pathology visible on diagnostic imaging. If LSTV is present in such a patient, surgical treatment to resect the enlarged transverse processes of the lumbosacral junction is worth considering.