About one in ten Australian patients with lumbar radiographs has a lumbosacral transitional vertebra. Radiologists report fewer than a third of them. In a minority of these patients the transitional segment causes persistent low back, buttock or hip pain, often beginning in the twenties, that is treated for years as non-specific strain. The condition is absent from the Low Back Pain Clinical Care Standard and from Australian primary-care journals.

This guide sets out what a GP needs to identify it and move the patient to a diagnosis. It covers the history and examination findings that raise suspicion, the screening for serious pathology that comes first, and the differential diagnoses that coexist with a transitional segment. It explains which imaging a GP can request under Medicare, how to word the request, and how to read a report that calls the finding incidental or uses variable vertebral numbering. It describes conservative management under a chronic condition management plan, the diagnostic local anaesthetic injection that confirms the transitional articulation as the pain generator, and when and to whom to refer, with a referral letter template. A final section covers what the specialist will consider, the GP's role after surgery, and access and cost in the Australian public and private systems.

Every clinical figure is drawn from the published evidence.