Congenital lumbar sacralization is very common. Generally speaking, congenital lumbar sacralization does not require special treatment. It is caused by congenital maldevelopment and usually has no symptoms. If there is local pain, it is likely caused by chronic lumbar muscle strain or strenuous exercise. It can be treated by taking some oral drugs to relax the muscles and promote blood circulation. You need to pay more attention to rest and avoid sitting for long periods of time or strenuous exercise. What symptoms are easily confused with lumbar sacralization? Lumbar degeneration: The lumbar spine is composed of five stacked vertebrae. Five pairs of lumbar crestal nerves extend from the neural foramina located between the posterior sides of the vertebrae. These crestal nerves, together with the nerves branching off from the sacral vertebrae below, form the largest peripheral nerve in the human body - the sciatic nerve. As we age, bone spurs grow and press on the nerve foramina, causing annoying symptoms such as back pain and sciatica. Thoracolumbar spine injury: Thoracolumbar spine injury mainly refers to the damage to tissue structures such as bones, ligaments and intervertebral discs, and the resulting damage to spinal nerve tissue. Due to the changes in the anatomical structure, there is no sternal manubrium in front of T11 and T12, and there are free ribs on both sides, so the stability is also worse than other thoracic vertebrae. The thoracic vertebrae are kyphotic and the lumbar vertebrae are lordotic, which makes it easy for the force of the spine to be transmitted downward. Generally speaking, T12-L2 fractures account for 60% of spinal fractures, and T11-L4 fractures account for 90% of spinal fractures. Therefore, the thoracic and lumbar fractures usually refer to T11-L4 fractures. Lumbar hypertrophy: also known as hypertrophic spondylitis or degenerative spondylitis, is a common cause of low back and leg pain in the elderly. When people reach middle age, the lumbar vertebrae begin to proliferate, hypertrophy, and develop bone spurs. Almost all elderly people have lumbar hypertrophy. On X-rays, it can be seen that the two sides of the spine have sharp shapes, like upturned lips, so some X-ray reports are called "lip-like hyperplasia." 1. Symptoms of lumbar transitional vertebrae (1) Overview: Generally, this type of deformity may not cause any symptoms, especially during adolescence. The diagnosis and classification of the deformity are mainly based on X-ray films. For patients with low back pain accompanied by lumbosacral deformity, other diseases should be considered first and a more comprehensive examination should be conducted. Only when no clear cause can the deformity be considered, among which kissing spine and floating spine deformities are the most common. (2) Symptoms of transitional vertebrae and their mechanism of occurrence: ① Increased load on vertebrae: Although sacralization of the lumbar spine can increase the stability of the lower back, the load on each of the remaining lumbar vertebrae is increased, causing strain and aggravating vertebral degeneration. ② Weakened stability of the vertebrae: Regardless of whether the thoracic vertebrae are lumbarized or the sacral vertebrae are lumbarized, the number of lumbar vertebrae increases and the lever becomes longer, which weakens the stability of the lumbar vertebrae and makes trauma, strain and degeneration more likely to occur. ③ Unbalanced weight-bearing of vertebrae: For patients with bilateral asymmetric lumbar sacralization, the side that has not been fused or has less fused is prone to damage to the surrounding soft tissue due to large amounts of activity; for patients on the other side who have formed a false joint with the ilium, since this type of joint is a juvenile joint and is difficult to absorb shocks caused by external forces, traumatic arthritis is likely to occur. ④ Nerve compression: When the lumbar spine becomes sacral, the dorsal branches of the spinal nerves running near the transverse process of the 5th lumbar vertebra are easily compressed by the hypertrophic transverse process and cause symptoms, especially when extending and bending sideways. ⑤ Reflex sciatica: It is very rare for sciatica to be caused by the deformity itself stimulating or compressing the sciatic nerve or its branches. Most of the time, sciatica symptoms appear reflexively due to stimulation of the peripheral nerve branches. Local (pain point) blocking therapy can make it disappear. 2. Classification (1) Lumbar sacralization: refers to the complete or partial transformation of the fifth lumbar vertebra into the sacral morphology, making it a part of the sacral mass. Clinically, the most common case is that the transverse process of one or both sides of the 5th lumbar vertebra hypertrophies into a wing shape and fuses into one piece with the sacrum, and often forms a false joint with the iliac crest; in a few cases, the vertebral body of the 5th lumbar vertebra (together with the transverse process) fuses into one piece with the sacrum. This deformity is more common. (2) Thoracic lumbarization: This refers to the 12th thoracic vertebra losing its ribs and forming a lumbar-like shape. If the 5th lumbar vertebra is not accompanied by sacralization, it still presents a lumbar shape and has the function of a lumbar vertebra. (3) Sacral lumbarization: The first sacral vertebra evolves into a lumbar-like shape. The incidence is very low and is mostly discovered accidentally when reading the film. It is usually asymptomatic. (4) Sacrococcygeal fusion: The sacrum and coccyx fuse into one piece, which is more common than the former. In addition to general symptoms in the waist, the diagnosis is mainly based on X-ray examination. |
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