Spina bifida occulta and lumbosacral transitional vertebra are the most common congenital lumbosacral malformations. Their association with low back pain and pain mechanism have been debated, and there is no consensus in the literature. Ferguson radiograph (AP radiographs angled cranially at 30°) in all radiographies and computed tomography in all radiological devices are the best imaging techniques for the identification of lumbosacral transitional vertebra. Several strategies have been recommended for the treatment of lumbosacral transitional vertebra, such as local injection of anesthetics and steroids, radiofrequency ablation, transverse process resection, foraminal decompression and/or posterior spinal fusion.