Prevalence of Lumbo-sacral Transitional Vertebra in Patients with Chronic Low Back Pain in South Kashmir: A Radiological Correlation Study

Background: Ac Lumbo-sacral transitional vertebra (LSTV) represents a common congenital anomaly at the lumbo-sacral junction, often associated with altered biomechanics, early degeneration and chronic low back pain (CLBP). Despite its clinical significance, regional data from South Kashmir remain limited. Objective: To determine the prevalence and types of LSTV among chronic low back pain patients in South Kashmir, using radiological evaluation (X-ray and MRI), and to assess associated degenerative changes and radiculopathy. Methods: This hospital-based cross-sectional study included patients aged 16–80 years presenting with chronic low back pain at MMABM Hospital, GMC Anantnag in South Kashmir, from June 2024 to May 2025. All subjects underwent lumbo-sacral spine imaging—either X-ray, MRI, or both. LSTV was identified and classified according to Castellvi’s classification1. Degenerative changes, adjacent segment disc pathology, and nerve root involvement were assessed. Data were analyzed for prevalence, laterality, and radiological correlations. Results: Of 208 patients evaluated, 35% (n=73) demonstrated LSTV on radiology. The most frequent subtype was Castellvi Type II (40%), followed by Type I (30%). Unilateral LSTV cases exhibited more severe degenerative changes and earlier disc space narrowing than bilateral types. Adjacent segment disc degeneration was observed in a majority of LSTV patients (70%), particularly at the L4–L5 level. Radiculopathy was present in a substantial proportion of cases with LSTV, frequently corresponding to foraminal stenosis or nerve root compression above the transitional level. Conclusion: LSTV is a frequent finding among chronic low back pain patients in South Kashmir, with a prevalence of approximately 35%. Unilateral variants are associated with more pronounced degeneration and radicular symptoms. Recognition of this variant on X-ray and MRI is vital for accurate diagnosis, classification, and management of low back pain