EC Orthopaedics

Bertolotti’s Syndrome is a rare but often underdiagnosed cause of chronic low back pain, resulting from a congenital lumbosacral transitional vertebra (LSTV). This anatomical variation, characterized by an abnormal articulation or fusion between the transverse process of L5 and the sacrum or ilium, can lead to mechanical stress, altered biomechanics, and secondary degenerative changes. Patients typically present with unilateral or bilateral low back pain, often resistant to conventional therapies. Diagnosis relies on imaging modalities such as X-ray, CT, and MRI, which reveal the bony anomaly and associated degenerative changes. Management includes conservative treatment with physical therapy, pain relief strategies, and, in refractory cases, surgical interventions.

 Keywords: Bertolotti’s Syndrome; Lumbosacral Transitional Vertebra; Chronic Low Back Pain; Spinal Biomechanics; Transverse Process Resection

1. JF Quinlan., et al. “Bertolotti's syndrome. A cause of back pain in young people”. Journal of Bone and Joint Surgery: British Volume 9 (2006): 1183-1186.
2. JM Jancuska., et al. “A review of symptomatic lumbosacral transitional vertebrae: Bertolotti's syndrome”. International Journal of Spine Surgery 9 (2015): 42.
3. AT Malik., et al. “Posterior lumbar fusions at physician-owned hospitals- Is it time to reconsider the restrictions of the affordable care act?” The Spine Journal9 (2019): 1566-1572.
4. AE Miller., et al. “Bertolotti syndrome”. StatPearls (2023).
5. MS Moreno García., et al. “Síndrome de Bertolotti: a propósito de un caso”. Revista Colombiana de Reumatologia (2016).
6. H Hachimi., et al. “Syndrome de Bertolotti”. Rev Maroc Radiol (2012).
7. Alonzo F., et al. “Bertolotti’s syndrome: an underdiagnosed cause for lower back pain”. Journal of Surgical Case Reports 10 (2018): rjy276.
8. Nardo L., et al. “Lumbosacral transitional vertebrae: association with low back pain”. Radiology2 (2012): 497-503.
9. Nojiri H., et al. “Lumbosacral transitional vertebrae torsional biomechanics”. The Spine Journal 11 (2014): S18.
10. Mahato NK. “Pedicular anatomy of the first sacral segment in transitional variations of the lumbo-sacral junction”. Spine 18 (2011): E1187-E1192.
11. Neelakantan S., et al. “Multimodality imaging in Bertolotti’s syndrome: an important cause of low back pain in young adults”. BMJ Case Reports (2016): bcr2016217121.
12. Jain A., et al. “Bertolotti syndrome: a diagnostic and management dilemma for pain physicians”. Korean Journal of Pain 4 (2013): 368-373.