Aim:This study aimed to evaluate the orientation of the sacrum, its influence on sagittal balance, and its practical relevance in identifying a sacralized L5 or lumbarized S1 as an LSTV to help prevent complications.Material and Methods:Lumbosacral vertebral roentgenograms from 633 outpatients who visited our hospital in 2018 we-re retrospectively reviewed and radiographic images were compared with sacral vertebrae classi-fied as anatomically normal, sacralized, or lumbarized. We measured the “Anterior Translational Arch (ATA1)” as a distance and the “Anterior Translational Angle (ATA2)” as an angular value.Results:The mean ATA1 was 16.84 ± 6.28 mm in the 527 normal cases, 4.21 ± 5.32 mm in the 71 sacrali-zation cases, and 21.17 ± 6.68 mm in the 35 lumbarization cases. (sacralization < normal< lumba-rization; sacralization < lumbarization; p < 0.05). ATA2 distribution among the 527 patients with normal anatomy was 10.58° ± 1.3°; among the 71 sacralization patients, 8.89° ± 1.13°; among the 35 lumbarization patients, 9.86° ± 1.76°.Conclusion:Careful radiological assessment is especially crucial in facilities that do not use neuronavigation and continue to perform stabilization and fusion using the free-hand technique, where this method and its measurements may help avoid numerous surgical errors.