Are you experiencing persistent lower back pain that seems different from typical back pain? This feeling of constant discomfort in the lower back could be linked to an anatomical peculiarity called lumbar sacralization L5.
Although little known to the general public, this condition affects a significant portion of the population and can significantly impact the quality of daily life. So you are not alone. to live with this anomaly.
What is lumbar sacralization, and should we worry if the doctor gives us this diagnosis? Is it related to back pain? What are the treatments to reduce the pain when it is present?
This popularized article, written by a health professional, explains everything you need to know about this spinal condition.
What is L5 lumbar sacralization?
Lumbar sacralization L5, also called Bertolotti syndrome, is a congenital anomaly where the fifth lumbar vertebra (L5) partially or completely fuses to the sacrum (triangular bone located under the lumbar region).
This condition was first described in 1917 by Italian physician Mario Bertolotti.
Precise medical definition
Sacralization is characterized by a abnormal fusion between the L5 vertebra and the first sacral vertebra (S1). This fusion can be:
- Unilateral (on one side only)
- Bilateral (on both sides)
- partial (extended transverse processes)
- Complete (total fusion of the vertebral body)
This anomaly results from an atypical embryonic development occurring between the 4th and 8th week of pregnancy, when the vertebral structures are formed.
Some figures to remember!
It is a more common condition than one might imagine, with an estimated incidence of 4-36% Population. In people under the age of 30, it is estimated that 18,5% are affected by lumbar sacralization.
Sacralization should not be confused with lumbarization, another birth defect of the spine. Less common, the lumbarization is a condition where the first sacral vertebra (S1) is separated from the other sacral vertebrae instead of being fused to them.
How to diagnose L5 lumbar sacralization?
Diagnosis is made by medical imaging. Generally, an X-ray or CT scan is sufficient to determine the presence of lumbar sacralization, as well as its characteristics (bilateral, unilateral or hemi-sacralization, fused with the iliac bone, etc.)..
Castellvi classification: 5 types identified
The reference classification, established by Castellvi in 1984 and recently updated, distinguishes 4 kinds lumbar sacralization:
Main types
- Type I : Widening of transverse processes (>19mm)
- Type II : Pseudarthrosis between L5 and the sacrum
- TypeIII : Complete bone fusion
- Type IV : Combination of the previous types
Subtypes by laterality
Each type is divided into:
- " has " : unilateral
- "b" : bilateral
This classification is crucial because it determines the therapeutic approach. Types III and IV are generally more symptomatic and require specialized management.
Symptoms: consequences of lumbar sacralization
Sacralization of the last lumbar vertebra is not necessarily synonymous with back pain. In fact, it can be asymptomatic in many cases, mainly due to the adaptability of the human body.
Even today (and despite scientific studies), the relationship between sacralization and low back pain is unclear.
On the other hand, it is possible that lumbar sacralization causes symptoms in some people. A survey on lower back pain found that the number of people with lower back pain AND who also had sacralization ranged from 6 to 37%.
Furthermore, another survey suggested that the presence of L5 sacralization may aggravate pain in those who already suffer from back pain.
Symptoms will vary depending on the severity of the malformation, and each individual. In the presence of lumbar pain associated with sacralization, we speak of “ Bertolotti syndrome"
From a biomechanical point of view, it must be understood that an L5 vertebra fused with the sacrum modifies the functioning of the lumbar region and the sacrum. In particular, it affects trunk mobility, posture, the biomechanics of the upper and lower vertebrae, etc.
For example, lumbar sacralization can affect the center of gravity at the base of the spine. Because the fifth lumbar vertebra is fused with the sacrum, the fourth lumbar vertebra (L4) becomes the "last" lumbar vertebra.
Since the L4 vertebra is not anatomically suited to perform the same support functions as the L5 vertebrae, this causes compensations and overuse of this region.
En summary
Lumbar sacralization may remain asymptomatic if the body manages to adapt from an anatomical and biomechanical point of view. On the other hand, this condition can also affect back movements and posture, especially if the sacralization is unilateral. The overlying and underlying vertebrae will have to work harder, which can cause dysfunction.
More specifically, here is what can be observed in some people with lumbar sacralization:
- Lower back pain and muscle spasms (due to compensation of related structures)
- Scoliosis (due to altered biomechanics due to fusion)
- Postural disorders
- Morning stiffness: Many patients report particularly marked stiffness upon waking, requiring 15 to 30 minutes of “loosening up” before regaining normal mobility.
- Limited range of motion in the lumbar region
- Herniated disc (due to L5-S1 disk compression)
- disc protrusion and other disc disease overlying vertebrae (such as L4-L5)
- Lumbar osteoarthritis
- Zygapophyseal osteoarthritis
- Sciatica
- Cruralgia
5 Main Causes of L5 Lumbar Sacralization
Lumbar sacralization results from a combination of developmental and genetic factors.
1. Genetic abnormalities
The genes Pax1 and Pax9 play a crucial role in vertebral development.
Mutations in these genes can disrupt the normal segmentation of vertebrae.
2. Prenatal environmental factors
Certain maternal factors can influence fetal development:
- Folic acid deficiency during pregnancy
- Exposure to certain toxins (alcohol, tobacco)
- Viral infections in the first quarter
3. Embryological disturbances
During 4th to 8th week development, disruptions of somitic segmentation can lead to transition abnormalities.
4. Family predisposition
Although not hereditary in the strict sense, some families present a increased frequency vertebral abnormalities, suggesting a genetic component.
5. Hormonal factors
Maternal hormones and the intrauterine environment can influence the expression of spinal development genes.
Effective treatments: a comprehensive approach
The management of L5 lumbar sacralization has evolved considerably in recent years, favoring a personalized approach.
Conservative treatment (first line)
Conservative treatment remains the initial reference, with a success rate of 60 to 80% depending on the studies.
Anti-inflammatory drugs
- NSAIDs (ibuprofen, diclofenac): 2-3 weeks maximum
- Corticosteroids: in case of acute inflammatory flare-up
- Painkillers: paracetamol, tramadol if necessary
Warning !
Prolonged use of NSAIDs should be avoided due to gastrointestinal and cardiovascular risks.
Specialized physiotherapy
Rehabilitation constitutes the pillar of conservative treatmentEarly management significantly improves long-term outcomes.
- Muscle strengthening: deep core muscles
- Specific stretches: posterior chain and psoas
- Manual therapy: gentle joint mobilizations
- Postural education: protective gestures and postures
A physical therapy program typically lasts 6 to 12 weeks, with bi-weekly sessions.
Therapeutic infiltrations
Associated infiltrations represent an intermediate option between medical and surgical treatment.
- Epidural infiltrations : corticosteroid injection into the epidural space to reduce inflammation around the nerve roots. This technique provides temporary relief for 3 to 6 months in 70% of cases.
- Facet infiltrations : targeting posterior joints for osteoarthritic pain. Particularly effective for mechanical pain aggravated by extension.
- Infiltrations of pseudarthrosis : recent technique directly targeting the abnormal fusion zone. This innovative approach shows promising results but requires high technical expertise.
Modern surgical treatments
When conservative treatment fails after 6 months, several surgical options can be considered. The surgical decision should always be carefully considered and discussed with the patient.
Transverse process resection
- Minimally invasive technique preferred
- Success rate: 70-85% according to recent studies
- Recovery: 6-8 weeks on average
This intervention aims to eliminate the mechanical conflict responsible for the pain.
Lumbar arthrodesis
- L4-L5 or L5-S1 fusion depending on the case
- Percutaneous techniques increasingly used
- Indications: associated instability, failure of other treatments
Arthrodesis remains a solution of last resort, reserved for the most complex cases.
Radiofrequency ablation
- Emerging technique for chronic pain
- Outpatient procedure under local anesthesia
- Promising short-term results
In addition to the treatments mentioned above, there are several products and accessories available on the market to relieve lower back pain related to lumbar sacralization.
Among the products recommended by our professionals, we have:
acupressure mat
- 🧘 𝐔𝐍 𝐄𝐍𝐒𝐄𝐌𝐁𝐋𝐄 𝐔𝐍𝐈𝐐𝐔𝐄 𝐓𝐎𝐔𝐓-𝐄𝐍-𝐔𝐍 – Wellax acupressure set leaves nothing to desire: For a complete and perfect wellness experience, you will receive a matching spiked cushion with our acupressure mat!
- 🧘 𝐋𝐈𝐁È𝐑𝐄 𝐃𝐄 𝐋𝐀 𝐓𝐄𝐍𝐒𝐈𝐎𝐍 – Our fakir mat stimulates the muscles, promotes circulation and can thus effectively relieve tension. This is how you fight annoying back and neck pain!
- 🧘 𝐃𝐈𝐒𝐒𝐈𝐏𝐄 𝐋𝐄 𝐒𝐓𝐑𝐄𝐒𝐒 𝐑𝐎𝐔𝐓𝐈𝐍𝐈𝐄𝐑 – Whether after a training session, a match or a hard day work: The Wellax acupuncture mat is the ideal support for releasing daily tension. Pure relaxation for body and soul!
Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
Lumbar belt heated
- 【360° Powerful Support】The heavy lifting back brace, equipped with 4 stainless steel brackets and 2 springs, provides 362° strong support for the lower back and helps decompression of the spine. It prevents injuries from physical exertion, prolonged sitting or standing, housework and work.
- 【Pain Relief】This ergonomic back support strengthens the lumbar area and abdominal muscles, relieving fatigue, tension and injuries. It also helps alleviate pain related to herniated discs, sciatica and scoliosis.
- 【3 Heating Modes】The lower back pain brace has a heating pillow Adjustable via a controller, with 5 temperature levels (low, medium, high) to improve blood circulation and soothe back pain.
Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
Ergonomic back cushion
- ✨Premium Material: Our lumbar support cushion is filled with new temperature sensitive sponge, the lumbar support can adjust the contour of your back according to the temperature. The outer layer of lumbar cushion is made of high quality breathable fabric. The back support cushion fabric is comfortable and soft, not easy to fade. The parts of the lumbar cushion have been certified and are safe and harmless to human health.
- ✨High-quality design: The back support cushion for chair is ergonomic, and the pillow for back pain has a partitioned design, the memory foam back cushion can support your back curve and promote healthy posture. The lumbar support cushion for chair uses elastic straps to keep the lumbar support cushion for sofa firmly fixed on the seat.
- ✨Protect your health: With our car back support, you can better protect your spine, car back support office chair Helps relieve lower and middle back tension caused by prolonged sitting or driving. If you often experience back pain due to prolonged sitting, you should definitely try an office chair back cushion.
Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
massage gun
- DEEP TISSUE MASSAGE GUN – ALDOM Muscle Massage Gun for Athletes is ideal for relieving muscle pain, soreness and stiffness, promoting blood circulation and helps speed up warm-up and cool-down. It also helps restore the body faster and can be used as your percussion massager at the gym or sports club, is held with one hand and has a comfortable handle.
- 6 MASSAGE HEADS + 30 SPEED - The deep tissue massage gun comes with 6 different massage heads to help relieve sore muscles, 30 adjustable speed modes, Choose the speed and massage heads that best suits your needs. your needs (1 to 800 pulses per minute) to target different body parts and muscle groups, Integrate a percussive massage experience. Reduce muscle recovery time.
- SUPER QUIET AND POWERFUL MASSAGE GUN - Professional handheld percussion massager. Featuring a powerful, high-penetration motor, the deep tissue massager is designed to send waves of relaxation and relief throughout the body, and increase everyday mobility and flexibility with percussive therapy for pain relief joints and muscle pain and prolongs the duration of muscle massage
Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
What about natural remedies?
Like accessories and anti-back pain products, natural products and grandmother's remedies are very popular with people suffering from back pain.
Often, these remedies include anti-inflammatory properties to relieve various body pains.
However, it should be noted that most of these natural products are not scientifically proven. It is therefore important to speak to your doctor before using them, particularly to avoid any interaction with your medications.
Natural remedies that could relieve symptoms include:
Turmeric
Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
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Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
Ginger
In addition to the particular flavor it brings to cooking and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
- 【Natural Ginger Foot Patches】: Natural Foot Detox Patch with Ginger and…
- 【Ginger Anti Swelling Detox Patch】: Ginger Detox Patches are natural,…
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Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
Omega-3
Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove to be very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly.
- ✔ WHY NUTRAVITA OMEGA 3 FISH OIL? – Our Omega 3 Fish Oil is naturally sourced from the rich waters of the Peruvian coast. The oils are then distilled for increased purity to provide the highest levels of contaminant-free Omega 3 fatty acids – EPA and DHA, removing metals, PCBs and other toxins. At 2 capsules per daily serving, our supplement provides a maximum strength of 660 mg of EPA and 440 mg of DHA. You also get 240 capsules per bottle for a 4 month supply.
- ✔ WHY OMEGA 3? – Each recommended daily dose of our premium Omega 3 fish oil supplement provides high-potency essential fatty acids – Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) both contribute to the maintenance of various bodily functions, most importantly the normal functioning of the heart. DHA, on the other hand, supports the maintenance of normal brain function and normal vision. All claims are substantiated by EFSA (European Food Safety Authority).
- ✔ 3RD PARTY LAB TESTED – Each ingredient is quality tested before the manufacturing process begins, each batch of our supplement undergoes rigorous quality testing. Our products have been third party tested for heavy metals and unwanted compounds by one of the best testing centers in Europe, the lab is Ukas accredited to ISO/IEC 17025:2017 standards. The results are then analyzed and certified by another top lab.
Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
Lemon eucalyptus
Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
- Eucalyptus Citriodora Essential Oil.
- 100% pure.
- Botanical name: eucalyptus citriodo.
Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
wintergreen
Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the essential oils most used in aromatherapy. This oil, extracted from the shrub of the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.
- PROPERTIES ORGANIC WINTERGOOD ESSENTIAL OIL: Wintergreen essential oil is…
- DIRECTIONS FOR USE: Refer to the instructions or ask your pharmacist for advice, This…
- PURESSENTIEL DNA: A range of 55 essential oils essential for well-being in the…
Last updated on 2025-07-28 / Affiliate links / Images from the Amazon Partners API
Prevention and recommendations
Although it is impossible to prevent L5 lumbar sacralization (congenital anomaly), certain measures can limit its impact.
From childhood (early screening)
- Pediatric examination : search for signs of asymmetry
- Scoliosis : growth monitoring
- Physical activity : harmonious development
Postural education
- Carrying a school bag : weight distribution
- Sitting : school ergonomics
- Exercices : playful reinforcement
As an adult
After age 30, we naturally lose 3 to 5% of muscle mass per decade, making maintaining muscle mass especially crucial for people with sacralization.
- Resistance exercises : 2-3 times a week
- Protein intake : 1,2-1,6g/kg of body weight
- Recovery : quality sleep (7-9 hours)
La weight management represents a major challenge: each additional kilogram generates 4 kg of pressure on the lumbar discs, thus multiplying the mechanical constraints in people with sacralization.
- Optimal BMI 18,5-24,9
- Balanced diet : anti-inflammatory
- hydration : 2L per day for the discs
When to consult a doctor ?
Certain situations require urgent or scheduled medical care.
Urgent consultation (within 24 hours)
- Intense pain and sudden (trauma)
- Loss of strength in the leg
- Sensory disorders : numbness, tingling
- Sphincter disorders : incontinence, retention
Scheduled consultation
- Chronic Pain for more than 6 weeks
- Functional limitation : daily difficulties
- Processing failure : no improvement
- Progressive worsening : increasing intensity
FAQ (your most frequently asked questions)
L5 lumbar sacralization and disability – Can I be recognized as disabled?
L5 sacralization may justify MDPH recognition if it generates significant functional limitations. A complete medical file is required.
L5 Lumbar Sacralization and Pregnancy – Can I Have Children Normally?
Pregnancy is possible but requires specialized monitoring. The weight of the baby can aggravate lower back pain in the third trimester.
Message of hope
This condition has a name and solutions. With appropriate care and a few daily adjustments, the vast majority of patients lead normal, active lives. The important thing is not to let symptoms take hold and to seek medical help at the first sign.
Talk to your doctor if you experience persistent lower back pain. Early diagnosis allows for better management and significantly improves quality of life.