Partial sacralization of l5 treatment Dec 14, 2009 · Sacralization of L5 vertebra entails morphological alterations in the sacrum. S. In lumbosacral transitional vertebrae either sacralization of the lowest lumbar segment or lumbarization of the upper sacral segment of the spine is seen. In this video Dr Madhur Thawani B. 1a is anterior, 1b posterior. By Chris Faubel, M. C. Partial Sacralization of L5 Vertebra, Mild lumbar spondylosis with annular tear with diffuse disc bulge with mild focal posterocentral and right subarticular disc protrusion at L4-L5 level causing mild thecal sac indentation, right neural foraminal narrowing and mild right L5 traversing nerve root compression. 21,22 Such a phenomenon may alter the dynamics of sacroiliac relaxation and sacral nutation patterns during Anatomy . Nov 29, 2024 · Partial sacralization of L5 is a congenital anomaly, meaning it's present from birth. In complete sacralization, the L5 vertebra is completely fused with the sacrum, while in incomplete sacralization, there is a partial fusion between the L5 and S1 vertebrae. Key Words:A lumbar spine, manipulation therapy, Oswestry, sacralization lumbosacral transitional vertebra (LTV) refers to a total or partial unilateral or bilateral fusion of the transverse process May 7, 2020 · Sacralized and Normal sacra. Reason for pain . Sacralization of L5 is a fairly common Xray finding, congenital, and of little significance unless you are a spinal surgeon planning an instrumented fusion of the lumbar spine. T, F. Medications include: • NSAIDs; Nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain and reduce inflammation common to osteoarthritis. . Jun 28, 2016 · Sacralization of the fifth lumbar vertebra, also known as Bertolotti’s syndrome, is a congenital transitional anomaly of the lumbosacral spine characterized by a transverse mega-apophysis of L5 merging or articulating with the iliac wing and/or sacrum; it can Jul 21, 2023 · 5 lumbar segments (24 presacral vertebrae with normal anatomy, partial L5 sacralization, or partial S1 lumbarization): a thin nerve joining a thicker nerve at the lateral sacrum represents the peroneal branch of L4 and the L5 nerve Lumbarization- is actually a congenital abnormality, meaning it is present in an individual from birthSacralization- is a common irregularity of the spine, w Aug 1, 2021 · LSTVs are congenital vertebral anomalies in which elongated fifth lumbar (L5) transverse process(es) (TP) articulate or fuse to the first sacral segment (S1). Sacralization is a common irregularity of the spine, where the fifth vertebra is fused to the sacrum bone at the bottom Sacral dysmorphism/lumbar sacralization are interchangeable terms used to describe morphotypes of the lumbar vertebrae: (a) Normal anatomy. The sacrum is the triangular bone in the lower back. Additionally, in some cases, a true or false form of the disease is diagnosed. There are several types of spinal cord injury that can affect the lumbar spine: Sacralization. (See also Chap. MRI studies can be helpful for central or foraminal stenosis. e. , Milecki M. Partial sacralization is characterized by a compound of only half. In the spines of these patients, the enlargement of the caudal lumbar vertebrae at the transverse process leads to the fusion or articulation of the transverse process with the sacrum or the ilium, causing discogenic disease and limiting mobility. been an effective treatment approach for this patient with LBP associated with a type IIA LTV. Feb 1, 2008 · Radiological analysis. However, no study has examined the impact of L5 sacralization on fusion rates and clinical outcomes of patients who undergo L4–L5 PLIF surgery. It’s only when it causes LBP that Jan 24, 2019 · The fifth lumbar vertebra, known as L5, may fuse fully or partially on either side of the sacrum, or on both sides. QI customises every treatment protocol depending on the needs of the patient. He Veteran therefore has a current back disability. The diagnosis was corrected to Jul 20, 2008 · Find partial sacralization information, treatments for partial sacralization and partial sacralization symptoms. 5%) is Individualized Treatment Protocols Treatment protocols for lumbarisation and sacralisation focus on strengthening and maintaining pelvic floor muscles in order to increase mobility and flexibility. Abstract Background: Bertolotti syndrome (BS) is defined as a congenital anomaly of the spine that includes sacralization of the lowest lumbar vertebra or lumbarization of the first sacral vertebra (i. Which persists for more than three months and are asymptomatic (no signs or symptoms). In this region, the curvature of the spine changes from lumbar lordosis (forward curve) to sacral kyphosis (backward curve). Due to sacralization, the L5 vertebra appears and works more like the sacral components and hence it is termed as sacralized vertebra. — Bertolotti’s syndrome is an atypical cause of axial low back pain or buttock pain caused by a transitional lumbar vertebrae with a large, “spatulated” transverse process that either fuses with the sacrum (sacral ala) or ilium, or forms a pseudo-articulation at that location. Dec 24, 2024 · Flexion and extension lateral lumbar radiographs can identify the degree of instability. Jan 5, 2010 · Transitional states of vertebrae at the lumbosacral junction are associated with low back pain. The remnants of the original sacra in these specimens presented grossly diminished parameters. At and close to the SI joint on the side(s) of the false joint : The false joint (anomalous articulation) is the partial connection between the L5 transverse process and forms a connection that looks like a joint. Nov 6, 2020 · Bertolotti Syndrome is a diagnosis given to patients experiencing pain caused by the presence of a lumbosacral transitional vertebra (LSTV), which is characterized by enlargement of the L5 transverse process (es), with potential pseudoarticulation or fusion with the sacrum. Lumbar sacralization was Oct 1, 2020 · Moreover, in the presence of traumatic L5 sacralization, only 1 case sustaining such injuries has been published in the literature [2]. Materials and Sacralization of L5 vertebra entails morphological alterations in the sacrum. The condition may be asymptomatic or cause back pain, stiffness, and other problems. You may have a partial disc separating a portion of the two bones. [Google Scholar] 16. alization can produce greater stress concentration at the adjacent segment (L4–L5); therefore, L4–L5 PLIF surgery in patients with L5 sacralization may negatively affect fusion rate and be associated with poor clinical outcomes. An anterposterior plain film demonstrates four lumbar vertebral bodies and a transitional vertebra at L5 with partial sacralization. I had a CT exam done and in the report it states Mar 5, 2020 · Human lumbar spine usually consists of five vertebrae; however, some individuals have vertebral anomalies with four or six lumbar vertebrae because of sacralized fifth lumbar vertebra (L5 Lumbar interbody fusion: A degenerated disc is removed and L5-S1 vertebrae are fused together with implants or bone grafts. Sacralization leads to fusion of the L5 (fifth lumbar vertebra) and S1 (first sacral vertebra) and the inter- vertebral Jun 1, 2012 · Manual therapy, including spinal manipulation soft tissue therapies and exercise/stretching, was used to address the presenting symptoms. 1). Jun 1, 2012 · Two patients with LSTV involving unilateral sacralization of L5, a Castellvi type IIIa variant, presented with back pain to a chiropractic clinic. Sacroiliac joints are normal. Results of treatment of unilateral sacralization of transverse process of the fifth lumbar vertebrae. The transverse process is the small bony projection on the right and left side of each vertebra. 1a, 1b: Mary Rose Skeleton 43 with bilateral complete sacralization of the fifth lumbar vertebra. firstly sacralisation of l5 s1 is not a major problem or disease . Different Lumbar Spinal Cord Injuries. Separation of S1 entails alteration of the anatomy at the lumbosacral junction that affects load bearing at the region. Feb 22, 2019 · OBJECTIVE The aim of this study was to evaluate the effect of lumbar sacralization on the level of vertebral slip and disc degeneration in patients with L4 spondylolysis. A long list exists, but the enlistment of sacralization as one of the causes has resulted in a lot of controversy. In patients with bilateral LSTVs, no difference in the iliolumbar ligament compared to that in controls was seen. While performing a fusion surgery, the spinal fixation of the S1 segment usually presents a greater risk of failure (pseudarthrosis) compared to L5. Where lumbarization is the presence of an extra bone in the lumbar spinal column due to the failure of the first and second sacral spine to fuse, sacralization is the fusing of the L5 vertebra with the sacral spine. We are presenting a unique case of an elderly man with severe extension type spinopelvic dissociation resulting in severe vertical shear and sacralization of L5 with intrapelvic S1 body displacement. Jul 25, 2023 · Bertolotti syndrome is a congenital disorder leading to back pain associated due to a lumbosacral transitional vertebra (LSTV). Mar 26, 2023 · Treatment of Sacralization. There is pseudoarticulation of the enlarged right transverse process with the sacrum (white arrow). The lumbar region of the spinal column mainly facilitates movement of the back and supports the body weight. T (USA) from Seva Physiotherapy Clinic, Ahmedabad is giving information about Sacralization L5 LSTVs include sacralization of the L5 vertebral body and lumbarization of the S1 segment while demonstrating varying morphology, ranging from broadened transverse processes to complete fusion. Approximately 2 weeks after initial treatment, the first patient subjectively reported a 70% improvement in symptoms, with lumbar extension increased to full in active range of motion at the lumbar spine but with continued tenderness and hypertonicity at the A rare finding in the lumbar column (unilateral dysmorphia of the lumbar transverse apophysis with sacral characteristics of the IV without sacralization of the V) Radiol Med. Sacralization is a congenital anomaly that occurs in the embryo. However, before birth, some individuals develop a condition where the lowest lumbar vertebra (L5) doesn’t fully determine whether it belongs to the lumbar spine or the sacrum. Jul 1, 2024 · The prevalence of LS in 6%–37% of patients with LBP and 30% with a herniated lumbar disc is an interesting finding denoting a possible association between LS and lower lumbar degeneration. Feb 26, 2024 · Sacralization is when your L5 vertebra is totally or partially connected to your pelvis. 3 Recent studies found that lumbar sacralization increases the chance of developing LBP, the severity, and the probability of lumbar disc herniation. The case The preoperational Lumbar JOA (Japanese Orthopaedic Association) score was 12. L5-S1 helps transfer loads from the spine into the pelvis and legs. Numerous causes have been attributed to low back pain (LBP). Malawski S. Partial sacralization of L5 is a condition where the fifth lumbar vertebra (L5) partially fuses with the sacrum. Approximately 2 weeks after initial treatment The L5-S1 spinal motion segment, also called the lumbosacral joint, is the transition region between the lumbar spine and sacral spine in the lower back. ” Feb 1, 2020 · Lumbarization of the first sacral segment occurs with separation, either partial or complete, of S1 from the rest of the sacrum, creating a sixth lumbar vertebra. Some call Bertolloti’s Syndrome “a partially sacralized L5. Location of Pain . Sacralization of L5 treatment includes medical, surgical and therapeutic treatments. Approximately 2 weeks after initial treatment, the first patient subjectively reported a 70% improvement in symptoms, with lumbar extension increased to full in active range of motion at the lumbar spine but with continued tenderness and hypertonicity at the CT scan shows four rib-free lumbar type vertebral and one transitional vertebrae characterized to assimilation of L5 to the sacrum. In most cases, sacralization does not require treatment, as it is typically asymptomatic and does not cause any functional impairment. The literature surrounding this Further investigations and images involved spine and pelvis computed tomography scans (Fig. 2a,b&c) in which we identified a severe extension type spinopelvic dissociation with fracture dislocation of L4, L5 and S1 with spinal pelvic dissociation, displacement of the L5 vertebral body to a sacralization position and intrapelvic displacement of Oct 1, 2022 · L5 vertebra and develop a treatment strategy aimed at Lumbosacral transitional vertebrae are congenital anomalies spanning a spectrum from partial/complete L5 sacralization to partial/complete with the L5 transverse elements, in comparison to the nor-mal, demonstrated 1) reduced IFD. known as sacralization of the L5 vertebra, in which the transverse process (TP) of L5 may be enlarged, come in contact with, or completely fuse to the sacral ala unilater-ally or bilaterally (Fig. whatever be the reason ,as the pain is not frequent,she needs to strengthen her back muscles and increase the spine stability to prevent back pain episodes. Sep 28, 2013 · Image courtesy Dr. Treatment is a trial of nonoperative management with NSAIDs and physical therapy. Lumbosacral transitional vertebrae (LSTV) are congenital anomalies of the lumbosacral spine. The fusion may put an excessive amount of strain on the surrounding joints, which can lead to arthritis and low back pain with early degenerative changes. Classically, there are varying degrees of fusion, unilateral or bilateral, between the last lumbar vertebra and the first sacral segment. Sacralization of L5 or sacralisation of fifth lumbar vertebra is a congenital anomaly, in which the lumbar vertebra, mainly its transverse process, gets fused or semi-fused with the sacrum or the ilium or to both. Dev … Mar 7, 2019 · Surgical treatment may be considered for cases requiring correction. Degenerative spondylolisthesis commonly develops at L4-L5. L5 Anterior View Showing Normal Transversus Process; L5 Posterior View Showing Normal Transversus Process Bertolotti Syndrome is a diagnosis given to patients experiencing pain caused by the presence of a lumbosacral transitional vertebra (LSTV), which is characterized by enlargement of the L5 transverse process(es), with potential pseudoarticulation or fusion with the sacrum. J Orthop Sports Phys Ther 2005;35:368-376. Mar 21, 2018 · The fifth lumbar vertebra, known as L5, may fuse fully or partially on either side of the sacrum, or on both sides. Each case is unique and one has to work out Changes in the morphology of the fifth lumbar or first sacral vertebrae are caused by “border shifting” are commonly reported spinal defects. Mario Bertolotti determined that in some patients, the transverse process on the last lumbar vertebra (L5) is elongated. Bone sacralisation is the most severe form, since it practically immobilizes the lumbar region. Mar 22, 2023 · Sacralization can be classified into complete and incomplete. 29,49 Best imaged on coronal MR imaging, the nerve root may be seen compressed between the hyperplastic transverse process of the LSTV and the adjacent sacral ala. This fusion can occur in one or both sides of the body. This transitional vertebra is described as forming through either the process of sacralization of the L5 vertebra or a lumbarization of the S1 segment [1]. One of the sacra from macerated cadavers has shown s … Extraforaminal stenosis leading to nerve root entrapment and radiculopathy has been reported in patients with an LSTV. (b) Partial sacralization where the lumbar transverse processes may be enlarged and articulate with the sacrum. 1950;36(4):307–311. VAOPGCPREC 82-90. 1c, 1d: Mary Rose Skeleton 1, normal Aug 15, 2024 · The Castellvi classification is used for lumbosacral transitional vertebra (LSTV): type I: enlarged and dysplastic transverse process (at least 19 mm) Ia: unilateral Ib: bilateral type II: pseudoarticulation of the transverse process and sacr Jul 1, 2010 · Fourth lumbar vertebrae in spines involved with complete sacralization of the fifth lumbar (L5) vertebrae and L5 vertebrae associated with lumbosacral accessory articulation were measured for the Jul 13, 2018 · Common: 1/2 of the L5 vertebrae is 'incorporated ' into your sacrum. The transverse process of L5 forms a diarhrodial joint or a bony union with the sacrum unilaterally: Sacralization: The transverse process of L5 forms a diarhrodial joint or a bony union with the sacrum bilaterally: LSTV: Sacralization of the lowest lumbar vertebra and lumbarisation of the uppermost sacral segment. This alteration may contribute to incorrect Dec 3, 2018 · Lumbosacral transitional vertebra (LSTV) is a congenital anomaly of the spine that arises because of mutations in the Hox genes, giving rise to sacralization (fifth lumbar vertebra shows assimilation to the sacrum) and lumbarization (first sacral vertebra shows lumbar configuration). Key Words:A lumbar spine, manipulation therapy, Oswestry, sacralization lumbosacral transitional vertebra (LTV) refers to a total or partial unilateral or bilateral fusion of the transverse process Jun 1, 2012 · Manual therapy, including spinal manipulation soft tissue therapies and exercise/stretching, was used to address the presenting symptoms. Feb 26, 2024 · Sacralization is when your L5 vertebra is totally or partially connected to your pelvis. Sacralization of L5 possibly represents a structural and biomechanical adjustment to compensate for reduced joint interfaces associated with smaller sacra. When the L5 is connected to the sacrum, it is not mobile. Jun 25, 2021 · In 1917, Dr. The levels of vertebral slip and disc degeneration in the group of patients with sacralization were significantly greater than in the group without sacralization. 4, 5 Bertolotti syndrome is a developmental abnormality wherein, the transverse process of the caudal most lumbar vertebrae is enlarged and shows pseudoarticulation with the sacral ala or ilium, leading to an uncommon cause of chronic lower back and gluteal region pain in young individuals. Oct 11, 2021 · It typically occurs when an elongated transverse process of the last lumbar vertebra fuses to the first sacral segment (i. only problem is the reduced stability and early onset Jan 12, 2024 · Bertolotti’s syndrome is the eponymous name of the congenital lumbosacral transitional vertebra (LSTV) that is liable for low back pain. it is fusion of two bones commonly caused by congenital reasons[changes at birth] or rarely caused by injury to bone. METHODS The authors analyzed data from 102 cases in which patients underwent surgical treatment for L4 spondylolysis and spondylolisthesis at their institution between March 2007 and September 2016. May 24, 2024 · The L5 and S1 vertebrae only partly fuse when sacralization is incomplete, whereas the L5 vertebra completely fuses with the sacrum bone. Sacralization refers to partial or complete fusion of L5 to the sacrum, with the lumbar vertebra often developing rudimentary sacral alae (or enlarged transverse processes) resulting in six sacral been an effective treatment approach for this patient with LBP associated with a type IIA LTV. Sacralization of the fifth lumbar vertebra (or sacralization) is a congenital anomaly, in which the transverse process of the last lumbar vertebra (L5) fuses to the sacrum on one side or both, or to ilium, or both. 3 about Sacralization and Lumbarization). To investigate sacralization of L5 on radiological studies of degenerative spondylolisthesis at L4-L5. D. Mar 8, 2019 · Sacralization leads to fusion of the L5 (fifth lumbar vertebra) and S1 (first sacral vertebra) and the inter-vertebral disc between them may be narrow. Conservative treatment options include pain management, physical therapy, lifestyle modifications, and heat or ice therapy. Bertolotti’s Syndrome is defined as chronic low back pain caused by lumbosacral transitional vertebrae. 2, 3 When Jun 21, 2021 · Introduction. 1 The degree of sacralization was first classified by Castellvi et al. It ranges from partial to complete L5 sacralization, and partial to complete S1 lumbarization. It most frequently occurs via an articulation of the L5 vertebra transverse process (es) with the sacrum, leading to irregular spinal mobility and pain. Lumbarisations, creating six lumbar vertebrae instead of the standard five, and sacralisations, creating four lumbar vertebrae, can sometimes be very troublesome. Feb 22, 2019 · Results: Lumbar sacralization was present in 37 (36%) of 102 patients with L4 spondylolysis. Physiotherapy for lumbar pain, weakened muscles, sciatic nerve pain, nerve symptoms and spinal traction in certain cases. Diagnosing the LSTV as the cause of the symptoms and condition is essential for accurate management of this syndrome. e, to varying degrees). Aug 27, 2019 · Because this bony projection is larger than usual, it can “fuse” with the sacrum. Lumbosacral transitional vertebrae (LSTV) are congenital spinal anomalies, in which an elongated transverse process of the last lumbar vertebra fuses with varying degree to the “first” sacral segment. The treatment of sacralization depends on the severity of symptoms and the impact on the patient’s quality of life. Sacralization is when the lowest lumbar vertebra (L5) becomes abnormally attached to the sacrum. Jul 21, 2023 · 5 lumbar segments (24 presacral vertebrae with normal anatomy, partial L5 sacralization, or partial S1 lumbarization): a thin nerve joining a thicker nerve at the lateral sacrum represents the peroneal branch of L4 and the L5 nerve Sacralization of L5 Treatment. From the case: Sacralization of L5 Jul 1, 2010 · Fourth lumbar vertebrae in spines involved with complete sacralization of the fifth lumbar (L5) vertebrae and L5 vertebrae associated with lumbosacral accessory articulation were measured for the Sacralization of the L5 vertebra is seen at the lower right of the image. 3 Sacralization of L5 (7. Oct 1, 2017 · In LSTV cases, a patient with partial L5 sacralization (unilateral or bilateral assimilation joints without osseous fusion) was considered to have 24 PSV, whereas a patient with complete L5 sacralization (unilateral or bilateral assimilation joints with osseous fusion) was considered to have 23 PSV. Sacralization is a congenital vertebral anomaly of the lumbosacral spine (fusion between L5 and the first sacral segment) . Sacralization of L5 is thought to cause stress concentration at Lumbar sacralization is common in adults with mild disc herniation who suffer from chronic low back pain. 1 LSTV, as a morphological variation, spans a spectrum from partial/complete L5 sacralization to partial/complete S1 lumbarization. Rebeca Monreal. Lumbarization may present as partial (incomplete separation of S1–S2 bodies and their neural arches) or complete separation of the S1 from the S2 segment in a sacrum. Sacralization of L5 on the right (fusion of the transverse process and alum of the sacrum) with ossification in the left L5 iliolumbar ligament from the L5 transverse process to the ilium (arrow). , lumbosacral transitional vertebra- LSTV) and the pain associated with this condition. Although an inaccurate judgment might occur when lumbar MRI was used alone , radiographs of the whole spine were taken on 23 December and revealed a type IB LZ with a type IV TD , the so-called complete LZ as classified by Lee et al. It involves the fifth lumbar vertebra (L5) partially fusing with the sacrum, the triangular bone at the base of the spine. Castellvi’s classification system is widely accepted for LSTV anatomy, but it measures only one aspect of transitional Jul 1, 2023 · Initially, treatment was effectively limited to MIS partial resections (also known as “reduction” or “decompression”) of the transverse process and/or ala of the transitional levels, but after a high rate of clinical failures of the resections for the Type 2 patients, we moved to a minimally invasive fusion paradigm for all 3 of the Finally, sacrum with a sacralization may present as complete L5 sacralization with bilateral higher position (type III) auricular surfaces, or unilateral (partial) lumbarization with one-sided high and one-sided low auricular surfaces. Feb 11, 2022 · Bertolotti syndrome correlates to significant underdevelopment of the iliolumbar ligament corresponding to the side of the LSTV as compared to the ligament on the contralateral side. On top of that, patients will often complain about intermittent low back pain with weakness, especially during the morning hours. 7 %€„ˆŒ ”˜œ ¤¨¬°´¸¼ÀÄÈÌÐÔØÜàäèìðôøü 433 0 obj /T 1201433 /L 1210246 /Linearized 1 /E 244150 /O 437 /H [ 2776 815 ] /N 11 Feb 13, 2023 · BACKGROUND Bertolotti’s syndrome is a condition of the lower back and/or L5 distribution leg pain caused by a lumbosacral transitional vertebra (LSTV). 29 Furthermore, patients with nerve root symptoms and an LSTV The sacralization of the fifth lumbar vertebra has been related to changes in the anatomy and biomechanics of the spine with no general agreement to its clinical significance, however Bertolotti’s syndrome should be considered as a differential diagnosis for lower back pain, therefore, its pathophysiology, epidemiology and treatment must be a Aug 13, 2020 · Chiropractic adjustment done on L-5. The examiner additionally diagnosed partial sacralization of the left L5 vertebra/lumbarization of S1. Use of lumbar belt or corset to reduce pain, inflammation and restricted movement during back pain, to protect back muscles as advised by physician. Oct 16, 2018 · A 25-year-old female with back pain. . Review of the Veteran's service treatment records (STRs) reveals that he was treated for back pain on many occasions during service. Exs, D. R, M. False Joint . Sacralization of L5 possibly represents a structural and biomechanical adjustment to compensate for reduced joint interfaces as … %PDF-1. The weight of the evidence, therefore, establishes that the L5 pseudoarthrosis and partial sacralization is a congenital defect. This puts more stress on lumbar vertebrae above it (L3-4 and L4-5). Sep 15, 2022 · When a fusion of the LSTV and sacrum (called sacralization) or pseudo-joint doesn’t hurt—and many don’t—it’s just a feature of your anatomy, present since birth. P. ,2 who categorized LSTVs into four types (Table 1). 1 This congenital Feb 26, 2024 · Sacralization is when your L5 vertebra is totally or partially connected to your pelvis. The LSTV was type IIa in 10 cases, type IIb in 7, type IIIa in 2, and type IIIb in 18. These facets above the L5-fused sacra, in fact, were the superior articulating facets of the fifth lumbar vertebrae. Lumbarization is when top of the sacrum (S1) can be separated from the sacrum and the lumbar spine appears to have 6 vertebrae, not 5. Facets of the zygapophyseal joints in the lumbar vertebrae are closer to each other in the upper pair in comparison to the lower pairs Aug 10, 2015 · 7. ’ In such cases, the L5 transverse process becomes enlarged, often forming a fake joint with the pelvis. Sacralization of the last lumbar vertebra occurs when the last lumbar vertebra is incorporated into the sacrum, resulting in 4 lumbar vertebrae. The Castellvi classificati … Jan 1, 2019 · Here's the discussion of sacralization of L5 casefile. This results in a ‘transitional vertebra. There is also rudimentary T12 ribs. The following types are also distinguished: bone; cartilaginous; articular. Because pseudoarthrosis of the L5 vertebrae due to partial sacralization is a congenital defect, entitlement to service connected benefits cannot be granted by aggravation, as a matter of law. vdwfjd hfih tlhq qire wicomy uljdahz xsy tguqgh xsuz uglgsv uhkpj hvctx hoiwl gtzgwp hnrpxe