Prevalence of lumbosacral transitional vertebra on lumbar CT and associated degenerative imaging findings in symptomatic patients

Purpose: This study aimed to assess the prevalence and distribution of lumbosacral transitional vertebra (LSTV) subtypes in patients with low back pain and investigate associated degenerative changes using lumbar CT imaging. Material methods: A retrospective review of 1.035 patients who underwent lumbar CT for low back pain between January 2023 and April 2024 was conducted. 133 with LSTV were identified and classified according to the Castellvi classification. The degenerative changes at the LSTV level, including pseudoarticular degeneration, disc narrowing, facet joint arthropathy, foraminal stenosis, and scoliosis, were evaluated. Results: LSTV was present in 12.85% of the patient population. Degeneration at the pseudoarticulation was observed in 67.7% of cases, with Types II and IV showing significantly higher rates (98.2% and 100%) compared to Types I (60%) and III (0%). Disc narrowing at the cephalad level was most common in Type III (90%). Facet joint arthropathy was observed in 85.7% of cases, while foraminal stenosis was only found in Type II (9.8%). Scoliosis was more prevalent in Types II (50.9%) and IV (50%) than in Types I (24%) and III (4.5%). Statistically significant differences were observed in pseudoarticular degeneration, disc narrowing, foraminal stenosis, and scoliosis. Conclusion: LSTV is common in low back pain patients, with Types II and IV showing early degeneration at the pseudoarticulation level that may contribute to symptoms, particularly in young and middle-aged individuals. Nerve root compression due to degenerative hypertrophy is common in Type II and requires careful examination of the LSTV region with imaging methods in symptomatic cases.