European Spine Journal

, Volume 27, Issue 5, pp 995–1004 | Cite as

A review of lumbosacral transitional vertebrae and associated vertebral numeration

  • Jayson Lian
  • Nicole Levine
  • Woojin Cho



To review the current literature on methods of accurate numeration of vertebral segments in patients with Lumbosacral transitional vertebrae (LSTVs). LSTVs are a common congenital anomaly of the L5–S1 junction. While their clinical significance has been debated, unquestionable is the need for their identification prior to spinal surgery. We hypothesize that there are no reliable landmarks by which we can accurately number transitional vertebrae, and thus a full spinal radiograph is required.


A Pubmed and EMBASE search using various combinations of specific key words including “LSTV”, “lumbosacral transitional vertebrae”, “count”, “vertebral numbering”, and “number” was performed.


The gold standard for spinal segment numeration in patients with LSTV remains whole spine imaging and counting caudally, starting from C2. If whole spine imaging is not available, the use of the iliac crest tangent sign on coronal magnetic resonance imaging (MRI) has fairly reliable sensitivity and specificity (81 and 64–88%, respectively) for accurate numeration of LSTV. The role of paraspinal anatomic markers such as the right renal artery, superior mesenteric artery, aortic bifurcation, and conus medullaris, for identification of vertebral levels is unreliable and should not be used.


A sagittal whole spine view should be added as a scout view when patients obtain lumbar MRI to standardize the vertebral numbering technique. To date, there has been no other method for accurate numeration of a transitional vertebral segment, other than counting caudally from C2.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Lumbosacral transitional vertebrae Vertebral numbering Radiograph Vertebral counting 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5554_MOESM1_ESM.pptx (259 kb)
Supplementary material 1 (PPTX 258 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Albert Einstein College of MedicineBronxUSA
  2. 2.Department of Orthopaedic SurgeryMontefiore Medical CenterBronxUSA

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