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Specifically, inconsistencies involving the classification and counting methods obscure accurate assessment of lumbosacral transitional vertebrae. Therefore, we aim to establish more reliable morphological and morphometric methods for differentiating between sacralizations and lumbarizations in clinical and paleontological contexts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Using clinical CT data from 145 individuals aged 14\u201347\u2009years, vertebral counts and the spatial relationship between the sacrum and adjoining bony structures were assessed, while the morphological variation of the sacrum was assessed using geometric morphometrics based on varied landmark configurations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of lumbosacral and sacrococcygeal segmentation anomalies was 40%. Lumbarizations and sacralizations were reliably distinguishable based on the spatial relationship between the iliac crest and the upward or downward trajectory of the linea terminalis on the sacrum. Different craniocaudal orientations of the alae relative to the corpus of the first sacral vertebra were also reflected in the geometric morphometric analyses. The fusion of the coccyx (32%) was frequently coupled with lumbarizations, suggesting that the six\u2010element sacra more often incorporate the coccyx rather than the fifth lumbar vertebra.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our approach allowed the consistent identification of segmentation anomalies even in isolated sacra. Additionally, our outcomes either suggest that homeotic border shifts often affect multiple spinal regions in a unidirectional way, or that sacrum length is highly conserved perhaps due to functional constraints. Our results elucidate the potential clinical, biomechanical, and evolutionary significance of lumbosacral transitional vertebrae.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajpa.24466","type":"journal-article","created":{"date-parts":[[2021,12,29]],"date-time":"2021-12-29T09:38:38Z","timestamp":1640770718000},"page":"690-707","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The morphological consequences of segmentation anomalies in the human sacrum"],"prefix":"10.1002","volume":"177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4707-5435","authenticated-orcid":false,"given":"Viktoria A.","family":"Krenn","sequence":"first","affiliation":[{"name":"Institute of Evolutionary Medicine University of Zurich Z\u00fcrich Switzerland"},{"name":"Department of Evolutionary Anthropology University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0911-0164","authenticated-orcid":false,"given":"Cinzia","family":"Fornai","sequence":"additional","affiliation":[{"name":"Institute of Evolutionary Medicine University of Zurich Z\u00fcrich Switzerland"},{"name":"Department of Evolutionary Anthropology University of Vienna Vienna Austria"},{"name":"VieSID Vienna School of Interdisciplinary Dentistry Klosterneuburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7579-703X","authenticated-orcid":false,"given":"Nicole M.","family":"Webb","sequence":"additional","affiliation":[{"name":"Institute of Evolutionary Medicine University of Zurich Z\u00fcrich Switzerland"},{"name":"Department of Palaeoanthropology Senckenberg Research Institute and Natural History Museum Frankfurt Frankfurt Germany"},{"name":"Institute of Archaeological Sciences, Senckenberg Centre for Human Evolution and Palaeoenvironment Eberhard Karls University of T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirella A.","family":"Woodert","sequence":"additional","affiliation":[{"name":"Institute of Evolutionary Medicine University of Zurich Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Prosch","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image\u2010guided Therapy Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9100-4183","authenticated-orcid":false,"given":"Martin","family":"Haeusler","sequence":"additional","affiliation":[{"name":"Institute of Evolutionary Medicine University of Zurich Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.18004217315"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2011.08.005"},{"key":"e_1_2_10_4_1","volume-title":"Developmental defects of the axial skeleton in paleopathology","author":"Barnes E.","year":"1994"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmor.1050040304"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001117"},{"key":"e_1_2_10_7_1","first-page":"113","article-title":"Contributo alla conoscenza dei vizi di differenziazione regionale del rachide con speciale riguardo all assimilazione sacrale della v. lombare","volume":"4","author":"Bertolotti M.","year":"1917","journal-title":"Radiologique Medica"},{"key":"e_1_2_10_8_1","volume-title":"Die Pathologischen Beckenformen","author":"Breus C.","year":"1904"},{"key":"e_1_2_10_9_1","first-page":"687","article-title":"The clinical significance of lumbosacral transitional anomalies","volume":"73","author":"Bron J. 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