ABSTRACT Lumbosacral transitional vertebrae (LSTV) are common congenital spinal anomalies that may redistribute mechanical loads to adjacent segments. This study aims to provide a comprehensive, quantitative synthesis of the relationship between LSTV 95% CI 0.86–1.91; p = 0.22). However, LSTV significantly altered the level of slippage. Patients with LSTV demonstrated strongly increased odds of spondylolisthesis at L4–L5 (OR 13.78; 95% CI 4.30–44.18; p < 0.0001) and a significant protective effect at L5–S1 (OR 0.07; 95% CI 0.02–0.23; p < 0.0001). No significant difference in slip severity was observed in pooled analyses ( p = 0.31). LSTV does not increase the overall risk of spondylolisthesis but acts as a biomechanical modifier that markedly redistributes pathology. It protects the transitional segment while shifting mechanical stress and instability to the cranial adjacent level (L4–L5).
Kapetanakis et al. (2026) studied this question.