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Case report

A forensic case of sacralization of the sixth lumbar
vertebra in skeletal remains. 

Tanaka N1, Kinoshita H2, Jamal M3, Tsutsui K4, Motomura H5, Ameno K6

Abstract
Lumbosacral transitional vertebrae (LSTVs) are a common congenital anomaly of the spine. In the pres-
ent case, we observed LSTVs in the excessive (sixth lumbar) vertebra. In forensic practice, this anom-
aly may be useful for personal identification of skeletal remains. 

Key Words: lumbosacral transitional vertebrae (LSTVs), skeletal remains, personal identification

Introduction
Personal identification is an essential subject in
forensic medicine [1,2]. Morphological character-
istics such as healed fractures, bone disease, con-
genital defects and prosthesis provide useful infor-
mation for personal identification in case of skele-

tal remains1-6. Here we describe lumbosacral tran-
sitional vertebrae (LSTVs), a congenital anomaly

in the part of spine7, in relation to forensic skele-
tal remains. 

Case History:
Almost completely skeletonized human remains
were found in a house, where an aged person had
lived alone. Anthropological findings led us to
determine that the deceased was a male between 60
to 80 years of age. The stature of the victim, cal-
culated from the length of the femoral bones, was
approximately 160-165cm, and the postmortem
interval was estimated at approximately 2-4 years.
No dental work, healed fractures, surgical inter-
vention or recent injuries were recognized. The

skeleton had extra lumbar vertebrae and sacraliza-
tion of a sixth lumbar vertebra (Type IIB) was
observed in the spine as a characteristic finding
(Figure 1). 

Figure 1. Anterior (a) and posterior (b) views of
the sacralization of the sixth lumbar vertebra in the
present case. 

Subsequent DNA examination using AmpFlSTR®
Identifiler® PCR Amplification Kit (Applied
Biosystems, USA) identified the remains as the
resident of this house. His age was within the esti-

1. Naoko Tanaka, Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750-
1, Miki, Kita, Kagawa, 761-0793, Japan.

2. Hiroshi Kinoshita, Department of Forensic Medicine, Faculty of Medicine, Kagawa University,
1750-1, Miki, Kita, Kagawa, 761-0793, Japan.

3. Mostofa Jamal, Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750-
1, Miki, Kita, Kagawa, 761-0793, Japan.

4. Kunihiko Tsutsui, Health Sciences, School of Nursing, Faculty of Medicine, Kagawa University,
1750-1, Miki, Kita, Kagawa, 761-0793, Japan.

5. Hiroyuki Motomura, Forensic Science Laboratory, Hyogo Prefectural Police Headquarters, 4-1,
Shimoyamate-dori 5-chome, Chuo-ku, Kobe, 650-8510, Japan.

6. Kiyoshi Ameno, Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750-
1, Miki, Kita, Kagawa, 761-0793, Japan.

Corresponds to: Dr. H. Kinoshita, Department of Forensic Medicine, Faculty of Medicine, Kagawa
University, 1750-1, Miki, Kita, Kagawa, 761-0793, Japan. E-mail: kinochin@med.kagawa-u.ac.jp

Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13

224



mated range. 

Discussion
Personal identification was performed by DNA
typing in the present case. LSTVs are common
congenital anomalies, and are defined as either
sacralization of the lowest lumbar segment or lum-
barization of most superior sacral segment of the

spine
7
. Four types of LSTVs have been classified

on the basis of morphological characteristics
8
. The

frequency of occurrence of LSTVs varies in differ-
ent human population groups, and it observed in 4-

24% of the general population
9
and in 15-18.1% of

the Japanese population
10,11

. However, as the fre-
quency of conversion of LSTVs into an excessive

vertebra is 1.6%
12
, its characteristic findings may

be useful for personal identification.  
It has been previously reported that low back pain

associated with LSTVs is called Bertolotti’s syn-

drome
13
. Although the relationship between LSTVs

and low back pain remains controversial
14
, it has

been reported that the incident of LSTVs in patient
with low back pain is higher than that of the gen-

eral population
9
. The person who has low back

pain seems to seek medical examination, and they
may have a higher opportunity to take X-ray films

of the spinal region
15
. 

Comparisons of radiological morphological fea-
tures between antemortem and postmortem X-ray
films have been performed for personal identifica-

tion in case of skeletal remains
16-20

. The morpholog-
ical characteristic findings of spinal region may
also provide useful information, if antemortem
lumbosacral X-ray films was available in the pres-
ent case.

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