Lumbosacral transitional vertebra
A lumbosacral transitional vertebra (LSTV) is a relatively common anatomical variant and can be seen in up 15% of patients 1. It can lead to operations performed at the wrong level if these are not recognised and clearly described in reports.
Depending on the number of thoracic vertebrae, lumbar vertebrae and sacral segments they can be thought of as lumbarized S1 segment or sacralized L5 segment.
Although a number of approches to identification of the true L5 vertebra have been proposed, nothing replaces accurate and diligent description of what numbering system has been used in all cases where numbering is non-standard.
The iliolumbar ligament is a relatively constant landmark on which to base lumbering. In over 96% of patients it arises from the transverse process of L5, although it is not always identified on routine MRIs of the lumbar spine 1.
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