Partial lumbosacral transitional vertebrae: 2 cases of unilateral sacralization

Area of Science:

• Chiropractic medicine
• Orthopedics
• Spinal anatomy

Background:

• Lumbosacral transitional vertebrae (LSTV) are common skeletal anomalies.
• Their role in low back pain is debated.
• Conservative management for LSTV-associated symptoms is infrequently documented.

Purpose of the Study:

• To report on the chiropractic management of two patients with unilateral sacralization, a type of LSTV.
• To explore the potential of chiropractic care in alleviating LSTV-related low back pain.

Main Methods:

• Two patients with LSTV (unilateral sacralization of L5, Castellvi type IIIa) presenting with low back pain were treated.
• Treatment included manual therapy, spinal manipulation, soft tissue therapies, and exercise/stretching.
• Symptoms were similar to piriformis syndrome.

Main Results:

• Patient 1 reported 70% symptom improvement within 2 weeks, with increased lumbar extension but persistent piriformis/gluteus medius tenderness.
• Patient 2 reported improved pain and mobility after 4 weeks, though prolonged standing remained difficult.
• Neither patient experienced complete symptom resolution.

Conclusions:

• Chiropractic management resulted in partial symptom resolution for both patients.
• Unilateral sacralization is proposed as a potential cause of back pain in these cases.
• Further research into conservative management of LSTV is warranted.