The fifth lumbar vertebra shows more anomalies than any other vertebra in the body. The commonest ones have to do with the transverse processes and the articulations.
The transverse processes show a great variety in structure. They may be short, almost rudimentary, long and slender, or broad and massive. The latter, in varying degree, constitute one of the most common anomalies. The transverse process and the whole lateral mass may articulate with the sacrum (so-called sacralization of the fifth) or may be actually fused with the sacrum. This may be either unilateral or bilateral.
Roentgenograms of the lumbosacral region, made in the usual anteroposterior and lateral projections, show in some cases the fifth lumbar joints in a fairly satisfactory manner. In others no joint detail can be seen. The difference in structure of the joints of different patients is the reason for the difference in the radiographic appearance.
TAYLOR RG. ANOMALIES OF THE LUMBOSACRAL ARTICULATIONS: CHAIRMAN'S ADDRESS. JAMA. 1939;113(6):463–465. doi:10.1001/jama.1939.02800310001001
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