its is congenital vertebral anomaly

1. Lumbarisation /Sacralization
Dr.Simranjeet Kaur (Pt)
Assistant Professor
MMIPR,MM(DU)

2. Lumbarisation
• Lumbarisation is an anomaly in the spine.
• It is defined by the nonfusion of the first and
second segments of the sacrum
• The lumbar spine subsequently appears to have
six vertebrae or segments, not five. This
sixth lumbar vertebra is known as
a transitional vertebra. Conversely the sacrum
appears to have only four segments instead of
its designated five segments..

3. • 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

4. • 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
be lumbarised.

7. Sacralization
• is often described as having one fewer vertebra
because the bottom lumbar segment (L5) is fused
to the pelvis. It can either being fused to the
sacrum below, or to the ilium at the side (the large
ear-shaped bones of the pelvis) or both.
• 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 L5
segment has more in common with its sacral
neighbours than its (mobile) lumbar ones, hence it
is said to be sacralised.

8. • 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.

9. Types
• 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. This is described more fully below.
• Partially sacralised joint (with a some degree
of movement) is more likely to develop
symptoms. also called Bertolotti's syndrome

10. Bertolotti's syndrome
• It is a pseudo arthrosis
• when a transverse process of L5 nudges
permanently up against the bone of the
pelvis. The pain of BS is typically one-sided
and felt where there is a 'bony hardness' at the
top of the back of the pelvis.

11. • more complex one-sided disturbance of the
biomechanics through the base of the spine.
• Leg length discrepancy may be implicated in
bringing symptoms of partial sacralisation to
the fore.

12. Full-
fusion unilateral sacralisation
• bottom lumbar segment has several knock-on
effects. The first is excessive movement strain
of the pseudarthrosis on the contralateral side.
One treatment option is to surgically fuse the
pseaudarthrosis although conservative
mobilising and self-treatment techniques to
make the false joint work better should be tried
exhaustively first.

13. A fused unilateral sacralisation
throws movement strain to the
contralateral joint at the same
level
Unilateral fused sacralisation causes
contralateral/cephalad movement strain
at higher lumbar levels.

14. Full fusion bilateral sacralisation
• commonly causes degenerative breakdown of
the L4 disc above, related to the altered centre
of gravity of the base of the spine. With the L5
fused to the sacrum, the seat of spinal
movement is raised. L4 - the 'new' spinal base
- lacks the secure shoring afforded L5 and this
can lead overuse syndrome and
developmental instability of the L4 segment.

15. Causes
• Generally patients experience LBP and there
are some points which enhance their symptoms
• Poor sitting posture that places stress on the
affected joints
• Twisting movements that can irritate nerve
roots
• Lifting heavy loads incorrectly
• Sitting for prolonged periods
• Low levels of physical activity

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

17. Treatment
• Depends on the nature of the anomaly and the
lumbarized sacral bone .
• Anti-inflammatory drugs, muscle relaxants for
back pain, swelling, inflammation.
• Injections and steroid treatment
• Surgical treatment may be considered for cases
requiring correction

18. Physiotherapy
• Improving the spine's supporting muscles
• Relieving strain on the discs and facet joints
• Reducing rigidity and enhancing mobility
• Increasing blood flow helps provide nutrients more
evenly throughout the body, notably to the spinal discs
• Endorphin release, which has the ability to reduce pain.
Endorphin release on a regular basis might lessen the
need for painkillers. Another benefit of endorphins is
the reduction of depressive symptoms, which are a
typical side effect of chronic pain.lowering the
frequency of back or neck pain attacks and the intensity
of the pain when they do occur

19. • Endorphins are chemical messengers in body,
released by both CNS and pituitary gland.
• Some studies suggests that endorphins play an
important part in body’s ability to manage pain
• Generally release during Exercise

20. LBP
• Stretching exercise
• Back Flexion Stretch
• Knee to Chest Stretch
• Kneeling Lunge Stretch
• Piriformis Muscle Stretch
• Hamstring stretch

21. Strengthening exercise for
Lumbarization
 Strengthening exercises focus on the core
muscles, including the abdominal, gluteus, and
hip muscles, in addition to muscles
surrounding the spine. All of the core muscles
are essential in supporting and minimizing
strain on the spine
 Transverse Abdominis Muscle Strengthening
(Abdominal Exercise)

22. • Gluteus Maximums Muscle Strengthening
(Buttock Exercise)
• Gluteus Medius Muscle Strengthening (Hip
Abductor Exercise)

23. Others…
• Pilates
• Yoga
• Tai chi
• Weight lifting and training
• Resistance bands
• Base ball
• Exercise ball

24. Lumbar stabilization exercises
• From static (lying) to dynamic (standing or
jumping)
• From resisting gravity to resisting additional
outside force
• From predictable to unpredictable movements
• From individual components of a movement to
the complete range of motion in a movement

25. Mobility exercise for lumbar spine:
• Low back Rotation
• Pelvic tilt exercise