Background: Lumbosacral transitional variations (LSTVs) are common within the spine, including sacralization of the lowest lumbar vertebral body and lumbarization of the uppermost sacral segment. Low back pain associated with an LSTV may arise from the level above the transition. LSTVs are common in the general population. LSTVs have been classically described as being best imaged on Ferguson radiographs. Symptoms can originate from the anomalous articulation itself, the contralateral facet joint, instability and early degeneration of the level cephalad to the transitional vertebrae, and nerve root compression from hypertrophy of the transverse process. Objective: To highlight the variations of lumbosacral anatomy. Materials and methods: We conducted a comperhensive electronic search in Pubmed, MEDLINE and Chocrane library databases, for articles that published between December 2003 and December 2018 using these keywords: lumbar and sacral vertebrae, lumberization, sacralization, low back pain and lumbosacral transitional variation. This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Results: From electronic searching, a total of 1160 studies were identified. 1060 studies remained after duplicates were omitted. Based on titles and abstracts, 900 studies were removed. Four were removed because they were ongoing studies and two were excluded due to inability to translate or obtain full text. An additional 146 were excluded based on full text records assessed for eligibility. Conclusion: Our systematic review demonstrated a difference in the dural sac (DS) termination level between groups of transitional vertebra with lumbarizaion and sacralization, which means that the position of the dural sac tip in the lumbarization group was significantly lower than in the sacralization group, and in the lumbarization group, the dural sac tip was located at the S3.