Sacralization and Its Impact on Lower Back Pain

Lumbarization of the sacrum

Dear Doctor: My L5 vertebra is underdeveloped and fused with the adjacent joint.
Could this be lumbar sacralization or sacral lumbarization? I experience daily back pain, especially when bending over.
I have researched online, and some doctors believe this condition does not cause pain, but I am in significant discomfort.
I have been taking medication for three months without improvement.
Additionally, I have sacroiliitis (on the left side of my pelvis), but my back pain occurs on both sides.
Could there be other underlying issues? I have undergone an MRI, and the doctor said there is no nerve compression.
However, sometimes when I wake up, I have no sensation in my legs, and I experience sharp pain and numbness in my lower back.
Is it possible that I have spondylolisthesis? My job requires lifting heavy objects, and the pain becomes more pronounced after work.
Could my vertebrae be displacing when I bend over and then returning to their original position when I straighten up? I am truly at a loss about what to do next and hope you can provide some answers.
Thank you, Doctor.
Also, I forgot to mention that my sacroiliitis is not due to ankylosing spondylitis, as I have undergone blood tests and skeletal scans.
Aside from having the HLA-B27 factor, everything else is normal.
I am really at a dead end...
Thank you.

A-Zhi, 20~29 year old female. Ask Date: 2004/07/27

Dr. Sun Ruisheng reply Orthopedics

In general, young individuals like Ah-Zhi often report muscle fatigue in the back, with over 90% experiencing chronic inflammation.
Only a small percentage have spinal or joint pathologies due to injuries or congenital structural differences.
This is particularly true for those who engage in frequent physical activity and rely on back strength for their work.
It's important to recognize that individual physical capabilities vary; not everyone can run 100 meters in 10 seconds, and not everyone can lift heavy objects without consequence.
Many people, due to economic necessity, engage in labor-intensive jobs, which can lead to years of accumulated pain that only manifests as symptoms later in life.
It is rare for young individuals to develop sacroiliitis, except for those with certain rheumatic or autoimmune conditions, such as ankylosing spondylitis, which can be confirmed through examinations or blood tests.
Generally, there are no cases where spinal displacement occurs with posture changes and then returns to normal, except for a few patients with spondylolisthesis, which can be verified through X-rays taken while the patient bends forward and backward.
If an MRI clearly rules out spinal compression, it provides more reassurance.
Therefore, it is recommended that Ah-Zhi consult with orthopedic and rehabilitation specialists for adjustments in lifestyle, temporary medication management, and physical therapy to address his concerns.

Reply Date: 2004/07/27

More Info

Understanding sacralization and its impact on lower back pain can be quite complex, especially when combined with other conditions such as sacroiliitis. Sacralization refers to a developmental anomaly where the fifth lumbar vertebra (L5) fuses with the sacrum, leading to a reduction in the number of lumbar vertebrae. This condition can potentially alter the biomechanics of the lower back and pelvis, which may contribute to pain.

In your case, the fact that you experience daily pain, particularly when bending, suggests that the sacralization may indeed be affecting your lumbar spine's function. While some medical professionals argue that sacralization itself does not cause pain, it is essential to recognize that pain is a subjective experience and can arise from various factors, including muscle strain, joint dysfunction, or nerve irritation.

Your history of sacroiliitis, which is inflammation of the sacroiliac joints located at the junction of the spine and pelvis, can further complicate your situation. The pain you describe on both sides of your lower back may be indicative of a broader issue involving the sacroiliac joints or the surrounding musculature. The fact that you have been taking medication for three months without improvement raises concerns about the underlying cause of your pain.

The symptoms you report, such as the tingling and numbness in your legs upon waking, could suggest nerve involvement, possibly due to inflammation or mechanical compression. While your MRI results indicate that there is no nerve compression, it is still possible for other factors, such as muscle tightness or joint dysfunction, to contribute to your symptoms.

Regarding your concern about spondylolisthesis (vertebral slippage), it is important to note that this condition can occur when there is instability in the spine, often due to a defect in the bony structure or excessive stress on the vertebrae. Given your job requires lifting heavy objects, it is plausible that repetitive strain could lead to such instability, especially if your lumbar spine is already compromised by sacralization.

To address your pain and improve your quality of life, consider the following recommendations:
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles supporting your spine, improve flexibility, and enhance overall function. A physical therapist can tailor exercises to your specific needs, focusing on core stability and proper lifting techniques to reduce strain on your back.

2. Pain Management: If over-the-counter medications have not provided relief, consult your physician about alternative pain management strategies. This may include prescription medications, corticosteroid injections, or other modalities such as nerve blocks.

3. Activity Modification: Since your job involves heavy lifting, it may be beneficial to explore ways to modify your work tasks to minimize strain on your back. This could involve using assistive devices or seeking help with lifting heavy items.

4. Regular Monitoring: Given your symptoms and the complexity of your condition, regular follow-ups with your healthcare provider are essential. They may recommend additional imaging studies or referrals to specialists, such as a rheumatologist for your sacroiliitis or an orthopedic surgeon for further evaluation of your spine.

5. Lifestyle Changes: Incorporating low-impact exercises, such as swimming or cycling, can help maintain fitness without exacerbating your back pain. Additionally, maintaining a healthy weight can reduce stress on your spine.

In conclusion, while sacralization and sacroiliitis can contribute to lower back pain, it is crucial to consider the entire clinical picture, including your work demands and lifestyle factors. A multidisciplinary approach involving physical therapy, pain management, and lifestyle modifications may provide the best chance for relief and improved function. Always consult with your healthcare provider before making significant changes to your treatment plan.

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