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Association Between Lumbosacral Transitional Vertebrae and Spondylolisthesis: A Systematic Review and Meta-Analysis
Stylianos Kapetanakis1,2, Mikail Chatzivasiliadis1, Christodoulos Kizis1
1Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.
Clinical Anatomy (New York, N.Y.)
|February 16, 2026
Summary
Lumbosacral transitional vertebrae (LSTV) do not increase overall spondylolisthesis risk but alter its location. LSTV protects the transitional segment, shifting instability to the L4-L5 level.
Area of Science:
- Spinal Biomechanics
- Congenital Spinal Anomalies
- Radiology
Background:
- Lumbosacral transitional vertebrae (LSTV) are common congenital anomalies.
- LSTV can alter mechanical load distribution in the spine.
- Understanding LSTV's impact on lumbar spondylolisthesis is crucial.
Purpose of the Study:
- To quantitatively synthesize the relationship between LSTV and lumbar spondylolisthesis.
- To analyze the prevalence, anatomical distribution, and severity of spondylolisthesis in individuals with LSTV.
- To determine how LSTV influences the biomechanics of adjacent spinal segments.
Main Methods:
- Systematic review and meta-analysis following PRISMA 2020 guidelines.
- Searched PubMed, Scopus, and Web of Science databases.
- Included 12 retrospective cohort studies (n=3929) comparing adults with and without LSTV.
- Assessed risk of bias using ROBINS-I and performed random-effects meta-analysis.
Main Results:
- LSTV was not associated with increased overall prevalence of degenerative spondylolisthesis (OR 1.28, p=0.22).
- LSTV significantly increased odds of spondylolisthesis at L4-L5 (OR 13.78, p<0.0001) and showed a protective effect at L5-S1 (OR 0.07, p<0.0001).
- No significant difference in slip severity was observed between groups (p=0.31).
Conclusions:
- LSTV acts as a biomechanical modifier, redistributing spinal pathology rather than increasing overall spondylolisthesis risk.
- LSTV protects the transitional segment (L5-S1) but shifts mechanical stress and instability to the L4-L5 level.
- This highlights the importance of considering LSTV in the evaluation and management of lumbar spondylolisthesis.
