Transitional lumbosacral vertebrae in children with pelvic fractures: frequency of diagnosis and distribution of types and subtypes

BACKGROUND: Various aspects of transitional lumbosacral vertebrae in children remain relevant due to a lack of research on several critical issues. For instance, the frequency of diagnosis and the distribution of different types and subtypes of this condition in the pediatric population remain unknown. The clinical features, particularly pain as the main symptom, have not been sufficiently studied. Furthermore, effective and pathogenetically based approaches to the treatment and prevention of low back pain associated with transitional lumbosacral vertebrae in different pediatric groups have not yet been developed. AIM: The study aimed to determine the prevalence and structure of transitional lumbosacral vertebrae in children with pelvic fractures. METHODS: This study included 41 children who sustained pelvic fractures between 2022 and 2024, with transitional lumbosacral vertebrae in 10 patients. The diagnostic protocol adhered to the standard for patients with pediatric trauma and included mandatory computed tomography of the lumbar spine and pelvis. Pelvic fractures were classified according to the Tile/AO classification system. Acetabular fractures were assessed using the classification criteria proposed by Judet et al. Transitional lumbosacral vertebrae types and subtypes were categorized based on the Castellvi classification. RESULTS: The diagnostic frequency of transitional lumbosacral vertebrae was found to be 24.4% ± 6.7% of clinical cases. Subtype IIa was the most common, accounting for 50.0% ± 15.8% of cases, followed by subtype IIIb, which occurred in 30.0% ± 14.5% of patients. Subtypes Ia and IIb each represented 10.0% ± 9.4% of the observed cases. The study revealed that, unlike in adult patients, a distinguishing feature of the condition in children was the absence of the main symptom, namely, pain in the lumbosacral junction. CONCLUSION: The high diagnostic frequency of this condition, which often remains latent for some time, highlights the importance of targeted radiological assessment of the lumbosacral junction. Once transitional lumbosacral vertebrae are identified, patients should be informed of their presence to support the joint development of individualized strategies for preventing lumbosacral pain.