From the Guidelines
Partial sacralization of L5 is a congenital anomaly that does not require treatment if it's not causing symptoms, and management should focus on conservative measures for low back pain, including physical therapy and pain management, as recommended by the American College of Radiology in their 2021 update 1. When symptoms are present, the goal is to alleviate pain and improve quality of life. The condition itself is a variation of normal anatomy rather than a disease, and many people with partial L5 sacralization experience no symptoms at all. However, some individuals may develop low back pain, altered biomechanics, or accelerated degeneration at adjacent spinal segments.
- Treatment typically focuses on conservative measures, including:
- Physical therapy to strengthen core and back muscles
- Pain management with over-the-counter medications like ibuprofen (400-800mg three times daily) or acetaminophen (500-1000mg every 6 hours)
- Activity modification to avoid movements that exacerbate pain
- Heat or ice therapy for relief
- In rare cases where pain is severe and persistent despite conservative treatment, interventional procedures like nerve blocks or surgery might be considered, but these are generally avoided unless absolutely necessary, as suggested by the American College of Radiology in their 2021 update 1. It's essential to note that imaging studies, such as MRI or CT scans, may be useful in evaluating the extent of the condition and guiding treatment, but they should be used judiciously and only when necessary, as recommended by the American College of Radiology in their 2021 update 1.
From the Research
Definition and Prevalence of Partial Sacralized L5
- Partial sacralization of L5 refers to a condition where the L5 vertebra is partially fused with the sacrum, resulting in an abnormal lumbosacral junction 2.
- This condition is a type of lumbosacral transitional vertebrae (LSTV), which can be unilateral or bilateral 3.
- The prevalence of LSTV is relatively common, with studies suggesting that it affects a significant portion of the population 4.
Clinical Presentation and Diagnosis
- Patients with partial sacralized L5 may present with low back pain, which can be similar to piriformis syndrome 2.
- Diagnosis is typically made using imaging techniques such as X-ray, computed tomography, or magnetic resonance imaging (MRI) 3.
- The condition can be recognized by the presence of a pseudo-articulation between the L5 vertebra and the sacrum 3.
Treatment and Management
- Conservative management, including manual therapy, soft tissue therapies, and exercise/stretching, can be effective in addressing symptoms 2.
- A proposed treatment algorithm for patients with low back pain secondary to Bertolotti's syndrome involves local anesthetic and steroid injection, radiofrequency ablation, and complete endoscopic resection of the pseudo joint 3.
- Surgical options, such as decompressive laminectomy, may be considered for patients who do not respond to conservative management 5.
Impact on Fusion Rates and Clinical Outcomes
- L5 sacralization can affect fusion rates and clinical outcomes after single-level posterior lumbar interbody fusion (PLIF) surgery at the L4-L5 level 6.
- Patients with type II or III L5 sacralization may have worse fusion rates after L4-L5 PLIF surgery than those with type I or no sacralization 6.
- However, pain intensity, clinical and surgical outcomes, and complications do not differ significantly between patients with and without sacralization 6.