Purpose: The contribution of lumbosacral geometry to the development of spine anomalies is unclear. This study tested whether sacral base angle (SBA), lumbar gravity line position (GL) and patient height (HP) are associated with low back pain (LBP) and spondylolisthesis. The study aimed to determine the validity of SBA and GL in radiological evaluation and as factors that predisposes the lumbosacraAl junction (LSJ) to certain derangements. Materials and Methods: The prospective study involved 488 adult patients. Patients with non-injury related LBP (84) and those (46) without LBP; age range: 16-80 years were included. The remaining patients (358) with injury-related LBP were excluded. Digital images of antero-posterior and lateral views of the lumbosacral spine of the patients were blindly examined by two consultant radiologists. Pathologies were identified and classified according to age and sex. SBA and GL were determined using Ferguson’s methods and height was measured using a health scale. Results: SBA (odds ratio: 1.045, P<0.05) and GL (odds ratio: 0.265, P<0.05) were significant factors predicting the development of LBP and spondylolisthesis, respectively. GL was found to be related to SBA (r=-0.409, p<0.01). Occurrence of LBP did not depend on age, sex, or HP. Discussion and Conclusion: SBA and GL are factors that should be considered when diagnosing noninjury related LBP and spondylolisthesis, respectively, as well as for correction of LSJ geometric distortion and when considering activities associated with transfer of large weights at the LSJ.