Prevalence and Clinical Impact of Lumbosacral Transitional Vertebrae in Chronic Low Back Pain: A Cross-Sectional Study from Central India

Abstract

Abstract Introduction: Lumbosacral transitional vertebrae (LSTV) are common anatomical variants implicated in chronic low back pain (LBP). Their prevalence and clinical significance remain debated. Materials and Methods: A hospital-based cross-sectional study was conducted among 350 consecutive adult patients (18–70 years) with chronic non-specific LBP at a tertiary care center in Central India. Demographic and clinical data were recorded, pain intensity assessed using the Visual Analog Scale (VAS), and disability quantified with the Oswestry Disability Index (ODI). Standardized lumbosacral radiographs were obtained and independently reviewed by experienced specialists. LSTV were classified according to Castellvi types. Statistical comparisons were performed between patients with and without LSTV, and across LSTV subtypes. Results: Of 350 patients, 198 (56.6%) were male; mean age was 42.8 ± 11.6 years. Radiographic LSTVs were identified in 78 patients, yielding a prevalence of 22.3%. Distribution by Castellvi type was: Type I (30.8%), Type II (25.6%), Type III (23.1%), and Type IV (20.5%). Patients with LSTV had significantly higher mean VAS (6.2 ± 1.4 vs. 5.4 ± 1.6; P = 0.002) and ODI scores (34.8 ± 9.7 vs. 29.1 ± 10.2; P = 0.001) compared to those without. High-grade LSTV (Types II-IV) were associated with greater pain and disability than low-grade variants (P < 0.05). ANOVA confirmed significant differences in ODI across Castellvi types, with Type III and IV showing the highest disability. Conclusion: LSTV were present in nearly one-fourth of patients with chronic LBP and were associated with significantly greater pain and disability, particularly in high-grade variants. Recognition of LSTV may aid in clinical evaluation and management of chronic LBP.