Pregnancy with Fifth Lumbar Sacralization

Patient

Q: I have an L5 sacralization and am now 23 weeks pregnant. My back specialist 5 years ago said I would have to go on bed rest in tri 3 and have a c-section when I did get pregnant so as not to be paralized but he has now told my OBGYN the opposite of that. She seems to not take me seriously about what I was told and how I feel now. What should I do? The pain in my back is between an 8-10 depending on the day and now I don't know what to do about the birthing process (C-section or not)? Please help me if you can.

Doctor

A:   Usually the five Lumbar vertebrae  are separate. Sometimes the bottom lumbar vertebra (L5) looks like is continued or fused with the sacrum. It's not completely separate, but it's not completely fused (usually) like the other bones in the sacrum (which form the triangular bottom of the spine and connect to the two hip bones through the sacroilliac joints).   L5 sacralization is a common anatomical anomaly, where usually the L5 vertebral body becomes incorporated into the S1 vertebral body. It is a common finding in the general population, and is a benign process. Similarly, one can have "lumbarization of the first sacral segment" in which the first part of the sacrum looks like it's trying to unfuse from the rest of the sacrum. The important message here is: either one of these situations might cause a tendency to get back pain or your pain probably led to the x-ray that revealed this condition in you. But nothing surgical needs to be done about either condition.  The suggested treatment is conservative IF you have symptoms, meaning pain: physical therapy, keep a good posture at all times, stretching and strengthen of the back muscles, keep your weight under control.. For long time, the clinical significance of this condition has been debated, and it has usually been associated with low back pain, however there have been studies reporting no relationship between Lumbar sacralization and back pain. It has also been associated with “sciatic pain”, disc herniation, and nerve root entrapment with radiculopathy, producing basically radicular pain (pain radiating in the distribution of the root affected), sensory symptoms, or weakness. These relationships are basically associations, and some patients can present with Lumbar sacralization without any symptoms.

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