Lumbarization of the S1 vertebra, what is sacralization of the L5 vertebra

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Lumbalization and sacralization

X-ray shows partial lumbarization in the sacral spine. There are several anomalies in the development of the sacrum and base of the spinal column that affect the free functioning of the spine.
Among such anomalies are lumbarization and sacralization. In the adult skeleton, the sacrum is a single bone of five fused vertebrae, located between the bones of the pelvis. The lower part of the sacrum is connected to the coccyx, the upper part to the last lumbar vertebra. It is here, in the last lumbar or upper sacral vertebra, that congenital pathological processes of lumbarization and sacralization manifest themselves.

General information

In approximately 2% of people, various congenital anomalies of the spinal column are detected, these include:

lumbarization - an increase in the number of lumbar vertebrae to 6, which can occur along with a simultaneous decrease in the number of sacral vertebrae to 4, that is, non-fusion of the last S1 vertebra with the sacrum occurs and its underdevelopment becomes similar to the lumbar one (sometimes can be called L6);
sacralization - an increase in the number of sacral vertebrae to 6-7 due to the assimilation of the lumbar vertebrae and the formation of the lumbosarcal vertebra.

ICD-10 code: Q76.4 Other congenital anomalies of the spine not associated with scoliosis : congenital anomaly of the spinal-sacral joint.

These developmental anomalies have no clinical significance and therefore can be considered by therapists as a kind of peculiar “norm”. Therefore, there are people who are diagnosed with lumbarization or sacralization of the L5 vertebra that this is such a minor deviation that makes them more unique.

What is dangerous about abnormal development of the sacrum?

In most cases, patients with four sacral and six lumbar vertebrae do not notice any pathologies and do not present any complaints, therefore, when lumbarization is accidentally detected, they do not attach due importance to the treatment and the necessary regimen. This approach is dangerous due to the high risk of complications, for example, osteochondrosis, kyphosis, scoliosis, spondylosis and other diseases based on deformation of the anatomical structures of the spine.

One of the possible complications is scoliosis

Almost 60% of patients with lumbarization have a pronounced curvature of the spine, which becomes noticeable at an early age and is diagnosed when passing a mandatory medical commission before entering a preschool educational institution.

Severe curvature of the spine

If at this stage no action is taken to correct the pathology, in the future the child may develop severe forms of stoop associated with displacement and deformation of the central axis of the spinal tube. With age, other abnormalities associated with underdevelopment of the sacrum will progress, for example:

displacement of the closing vertebra l6 during intense physical activity, for example, lifting weights;
backward deviation of the sacrum and disturbance of the center of gravity (affects posture, tone of the abdominal muscles and the functioning of the pelvic organs);

Normal and pathological pelvic positions
deterioration of blood circulation and changes in the structural features of paravertebral soft tissues in the area of the affected segment of the spine;
development of radicular syndrome (radiculopathy).

Radiculopathy

Radicular syndrome is a complex of pain and neurological symptoms resulting from compression and pinching of the nerve endings of the spinal nerves. The patient feels acute pain (lumbago), which can take a chronic course and last for several months and even years, characterized by alternating remissions and relapses.

Radicular pain syndromes

In patients with lumbarization of the first sacral vertebra, sciatic syndrome is often diagnosed, caused by compression of the largest and thickest nerve in the human body (sciatic), which passes through the coccyx and sacrum, the pelvic cavity and both limbs. Pain caused by compression of the sciatic nerve is called lumboischialgia.

Pinched sciatic nerve

Important! Severe lumbodynia and lumboischialgia (lumbago with sciatica) can cause a temporary limitation of a person’s ability to work, as well as the ability to move and perform self-care activities. If these pathologies develop against the background of lumbarization of the vertebra at the s1 level, timely measures should be taken to correct the root cause and associated complications (deformation of the vertebrae and intervertebral discs, displacement of the vertebrae, swelling and inflammation of soft tissues, inflammation of the nerve roots).

Pathogenesis

Normally, in the human spinal column there are 5 largest lumbar (L1-L5 vertebrae) in the form of a smooth lumbar lordosis and 5 fused sacral vertebrae, forming a large triangular-shaped bone of the upper posterior part of the pelvic cavity.

Normal structure of the human spine

The structure of the lumbar region experiences significant pressure from the upper body, which increases during bending, lifting, and carrying heavy objects. The sacrum is a wedge-like formation with pronounced vertebral bodies and less pronounced processes, which is located between a pair of pelvic bones. Its upper part is connected to the extreme lumbar vertebra, and its lower part is connected to the coccyx. The main function is support for all parts of the spine located above.

Sacralization is an increase in the number of sacral vertebrae, which usually occurs with a corresponding increase in the transverse processes of the lumbar vertebra and the sacral canal, as well as an increase in the number of sacral foramina. In this case, the L5 lumbar vertebra fuses by soldering to the sacrum and the lumbosacral vertebra , which is also sometimes called the transitional lumbosacral vertebra . It can be mobile or immobile, depending on the relationship of the transitional formation with the sacrum, the existing bone fusion on one or both sides. Thus, the lumbosacral vertebra is divided into the following types:

symmetrical with bilateral synostosis (continuous connection due to bone tissue) with the sacrum - fixed and with bilateral articulation - movable;
asymmetrical with one-sided synostosis makes it immobile; one-sided articulation ensures mobility, as well as one-sided synostosis and the presence of an articulation on the opposite side leads to immobility.

Lumbarization of the S1 vertebra - an increase in the number of lumbar vertebrae occurs due to the separation of the first sacral S1 vertebra and the second sacral vertebra and its transition to the lumbar region.

In the development of pain syndrome, great importance is given to the presence of mobility in the abnormal joint, in which the phenomena of spondyloarthrosis . In addition, the occurrence of pain may be associated with intervertebral osteochondrosis developing in the disc of an abnormal transitional vertebra, its degenerative growths towards the spinal canal, as well as possible stasis in the veins of the spinal canal and intervertebral veins.

Treatment

To treat lumbarization, painkillers are used, as well as non-steroidal anti-inflammatory drugs (Ibuprofen, Ketoprofen). Additionally, muscle relaxants and B vitamins may be prescribed. It is important to remember that only a doctor can select medications, taking into account the clinical picture and health status of the patient. Self-medication for diseases of the spine is unacceptable.

If the pathology is accompanied by poor posture, wearing an orthopedic corset may be recommended: with a fixed spine, it is much easier for the patient to move without experiencing pain.

Physiotherapy methods are used: massage, magnetic therapy, acupuncture. Physiotherapy can improve regenerative processes in the affected area, enhance cellular metabolism, and also help get rid of pain.

During lumbarization, physical therapy is extremely important. A set of exercises should be selected by an orthopedic doctor: it is important for the patient to avoid increased loads, jumping (especially from a height), as well as sharp flexion and extension of the back. It is acceptable to turn the body with a small amplitude, smooth bends, as well as gentle exercises for the back to strengthen the muscle corset.

In cases of severe pain, surgical intervention may be recommended. The doctor secures the additional vertebra, which helps prevent its subsequent displacement. The vertebra is fixed to the sacrum using an artificial intervertebral disc.

Regular exercises for lumbarization s1 allow you to completely get rid of the discomfort caused by the pathology. It is important that the set of exercises is selected by a physical therapy specialist. Otherwise, there is a risk of causing serious harm to your health.

Classification

Depending on the morphological features, sacralization of the vertebra and lumbarization can be unilateral or bilateral, true complete or partial - when bone fusion occurs in the enlarged transverse process of Lv with the sacrum or synchondrosis of the transverse process occurs in relation to its ilium (occurs in approximately 11% of cases) .

False sacralization usually occurs in lumbosacral scoliosis as a result of torsion and tilt of the Lv and the superimposed shadow of the transverse process on the ilium.

Consequences

The presence of an additional sacral vertebra causes the following consequences:

the lower back becomes less mobile, as a result of which a person’s movements become constrained;
the sacrum moves posteriorly, which affects posture and leads to the development of lordosis;
the center of gravity of the body changes.

One of the most important consequences of lumbarization is the “slipping” syndrome: when the patient tries to lift a heavy object, the additional vertebra “slips”, and its processes put pressure on the sacrum and on the nerves extending from the spinal cord. The result is an attack of severe pain in the lumbosacral region.

Causes

Lumbarization is an abnormal development or underdevelopment of the sacrum, which is a violation of the fusion of the sacral vertebrae and occurs during the period of neurulation and embryonic development at 4-5 weeks of pregnancy. The etiogenesis is not fully understood. The greatest role in this is given to the negative impact of external and internal, as well as risk factors:

unstable hormonal levels of the mother, for example, due to obesity , diabetes , hyper- or hypothyroidism ;
heredity;
frequent stress and the age of a woman carrying a child over 35-40 years old;
bad habits of the mother - smoking and alcohol abuse during pregnancy;
long-term use of oral contraceptives;
therapy with drugs that have embryotoxic effects;
infections.

Symptoms

Compression of the nerve structures of the spinal column can cause pain and neurological disorders. With lumbilization and sacralization, radiculopathy and radicular syndrome are sometimes observed along the nerve roots of the L5 and S1 vertebra, but are considered not to be associated with bone compression. Most often, such anomalies in the development of the spinal column cause symptoms after 40 years, including:

attacks of sharp or shooting lumbosacral pain, including lumboischialgia ;
limb sensitivity disorders;
limited mobility in the sacrolumbar region of the back;
severe forms of stoop ;
displacement of the vertebrae, especially during heavy lifting;
various spinal deformities, most often dysplastic scoliosis , especially with unilateral fusion.

Important! Anomalies of the ridge may not cause complications in youth, but significantly reduce the quality of life and cause pain at a more mature age - after 40, so it is very important to consult a specialist before they become irreversible.

Diagnosis of lumbarization and sacralization at the MART medical center

To diagnose lumbarization and sacralization, it is necessary to carefully collect the patient’s medical history, analyze the condition of the spine and ligamentous-muscular apparatus through a visual examination, and also conduct a study using an X-ray or magnetic resonance imaging scanner.

The obtained data and images make it possible to judge the nature of pathological changes, the possible manifestation of concomitant diseases of the spinal column and muscular system, as well as make a prognosis for the course of the disease.

Tests and diagnostics

The most pronounced unilateral form of the pathology, therefore other anomalies are detected by chance during routine health examinations. In addition, during the examination, the orthopedist, thanks to palpation, can detect the most painful and trigger points.

In some cases, difficulties arise in determining the identity of the transitional vertebra, that is, determining whether it is located in the lumbar or sacral spine. The most demonstrative method is considered to be a radiograph in various projections, including oblique. Additional examinations may include MRI and CT.

Diet for lumbarization

Diet for rheumatism

Efficacy: therapeutic effect after 2-6 months
Terms: 2-6 months
Cost of products: 1800-1900 rubles. in Week

There are nutritional approaches aimed at maintaining spinal health. The main recommendations include:

regular consumption of white meat;
enriching the diet with raw seeds and sprouts of sprouted wheat grains;
meeting the body's needs, mainly consuming dairy products, cereals, vegetables, dried fruits and their fresh analogues;
ban on caffeine, synthetic and fast food products;
maintaining weight by limiting simple carbohydrates.