LUMBARIZATION

AND
SACRALIZATION
PRESENTED BY: DR. MANSI PRAJAPATI
 LUMBARISATION

SACRALISATION
CONTENTS

MANAGEMENT
The human spine is composed of
vertebra namely- Cervical spine,
Thoracic, Lumbar, Sacral and the
Coccyx at the lower end.

There are 5 lumbar vertebrae and 5

fused sacral vertebrae, which are
based in the region of middle and
lower back and facilitate movements
of that part.
WHAT IS LUMBARISATION

Lumbarisation of S1 or lumbarisation
of the first sacral vertebra is a
It is also called as an extra vertebra,
condition in which the first sacral
additional lumbar vertebra or
vertebra is not completely attached
transitional vertebra. It occurs due to
to its fused sacral components but
non fusion of first and second sacral
instead this first sacral vertebra
segment.
appears like the other lumbar
vertebrae.
Lumbosacral transitional vertebrae consist of the process of the last lumbar
vertebra fusing with the first sacral segment.

While only around 10 percent of adults have a spinal abnormality due to

genetics, a sixth lumbar vertebra is one of the more common abnormalities.
Lumbarisation is where the uppermost segment of the sacrum is not fused.

Rather it is free to move and participates, along with the neighbouring

lumbar vertebrae in spinal activity. The first sacral segment is said to
Lumbarised.

This lumbarisation S1 vertebra may also have a disc like the other lumbar
segment or may have a disc space that remain undeveloped.
 This lumbarisationS1 vertebra is not
completely a fused nor does it become a
normal lumbar segment.
This makes it difficult to accommodate the
SIGNS & additional vertebral joint while performing
SYMPTOM daily tasks and may makes this vertebra
more vulnerable to injury and joint irritation.
S With advancing age and activities, the
lumbarised first sacral vertebra can find it
difficult
In some cases complaints like-
Back pain
Inflammation
Swelling
Stiffness of back
 Muscle spasms
Increased risk of injury
Inter-vertebral disc problems with
radiculopathy.
SACRALISATION

• Sacralisation 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.
• This fusion can occur in one or both
sides of the body.
• Sacralisation leads to fusion of the L5 and S1 and the intervertebral disc
between them may be narrow
• Sacralisation with the sacrum can be termed central sacralisation, whereas to
the sides it can be either uni- or bi-lateral transverse sacralisation.
• Being fused or semi-fused the LS segment has more in common with its sacral
neighbours than its (mobile) lumbar ones, hence it is called sacaralisation

With central sacralisation the
vertebra may be solidly fused or
there may be a slight degree of
movement through the presence
of a vestigeal L5 disc.
It is well possible to get to
advanced years being completely
unaware that you have one less
vertebra. Problems may only come
to the fore when fitness levels
diminish, particularly the strength
of the abdominal muscles
• Fully sacralised joint (that is fully fused) is
usually pain-free but causes symptoms
elsewhere at other joints - centrally at the
level above and contra-laterally at both the
same level and higher levels throughout the
lumbar spine.
• Partially sacralised joint (with a some
degree of movement) is more likely to
develop symptoms also called
Bertolotti's syndrome
Bertolotti's syndrome

• It is a pseudo arthrosis
• When a transverse process of L 5 nudges
permanently up against the bone of pelvis.
• The pain of BS is typically one-sided and felt
where there is ‘bony hardness’ at the top of
the back of the pelvis.
• More complex one-sided disturbance of the
biomechanics through the base of spine.
• LLD may be implicated in bringing symptoms of
partial sacalisation
 • Bottom lumbar segment has several knock-
FULL-FUSION on effects. The first is excessive movement
strain of the pseudarthrosis on the
UNILATERAL contralateral side.
SACRALISATI • One treatment option is to surgically fuse the
pseaudarthrosis although conservative
ON mobilising and self-treatment techniques to
make the false joint work better should be
tried exhaustively first.
 Commonly causes degenerative
breakdown of the L4 disc above, related to
the altered centre of gravity of the base of
FULL FUSION the spine. With the L5 fused to the
sacrum, the seat of spinal movement is
BILATERAL raised.
SACRALISATI
ON L4 - the 'new' spinal base - lacks the secure
shoring afforded L5 and this can lead
overuse syndrome and developmental
instability of the L4 segment.
CAUSES
Generally patients
experience LBP and Poor sitting posture that
Twisting movements that
there are some points places stress on the
can irritate nerve roots
which enhance their affected joints
symptoms

Lifting heavy loads Sitting for prolonged Low levels of

incorrectly periods physical activity
 • Lower back pain along with buttock pain
• Inflammation
• swelling
• stiffness of back
• Limited ipsilateral (same side of the body) flexion
Symptoms • Reduced mobility
• Muscle spasms
• Decreased coordination and flexibility
• increased risk of injury
• Sciatica or radicular pain patterns
• Chronic back pain in adolescents
DIAGNOSIS

Mainly X
CT Scan MRI
ray
TREATMENT

Depends on the nature of the anomaly and the

lumbarized sacral bone .
1. Anti-inflammatory drugs, muscle relaxants
for back pain, swelling, inflammation.
2. Injections and steroid treatment
3. Surgical treatment may be considered for
cases requiring correction
Rehabilitation-
Electrical modalities
 Specific treatment
Symptomatic treatment-
 Spinal traction
 IFT
TENS
 Ultrasound therapy
 SWD
 LASER
 Spinal corset , rest
CORE
MUSCLES?
 • Back flexion stretch
• knee to chest stretch
Stretching • piriformis stretch
• hamstring stretch
• quadriceps stretch
 Lumbar
stabilization
exercises
EXERCI
SE
 Pilates
Yoga
Tai chi
Weight lifting and training
OTHERS
Resistance bands
Base ball
Exercise ball
REFRENCES
• Essential orthopedics by J. Maheswari (5th edition)

• Essentials of orthopedics and applied physiotherapy by Jayant Joshi

(4th edition)

• CYNTHIA NORKIN