Bertolotti’s syndrome is an uncommon cause of low back pain, particularly focused along the waistline slightly off to the side, that is often confused with sacroiliitis. Bertolotti’s syndrome is a diagnosis given to someone with symptomatic pain due to a transitional vertebra that is inflamed. Although it is a very rare cause of back pain, Bertolotti’s syndrome is a very treatable diagnosis.
During our spinal development, the separate vertebrae in the sacral region, which is in the region of the pelvis, end up fusing together to form one bone called the sacrum. In the lumbar spine or low back, the lumbar vertebrae develop as separate segments with their own discs, transverse processes, and spinous processes, allowing us to have motion in our lumbar spine.
However, in the developmental stages, before birth, some patients’ lowest lumbar vertebra (called the L5 lumbar vertebra) could not quite decide to be part of the sacrum or not; it is considered a transitional vertebra. The transitional vertebra’s transverse process is often enlarged and often looks like a fake joint that touches the pelvis. This fake joint between this enlarged transverse process and the sacrum, if inflamed, can cause low back pain. This low back pain is often very similar to pain related to sacroiliac pain or even lumbar facet pain.
Most people with this transitional vertebra do not experience any symptoms. However, for the patients that do, it is important to rule out the other causes of back pain including pain related to the lumbar disc, pain related to the lumbar facet joints, and even pain related to the sacroiliac joint. This may require specific imaging studies or specific injections to rule out these other pain generators.
For those patients that do have pain related to pseudoarthrosis, we have great success using minimally invasive spine surgery to reshape the enlarged transverse process and remove this transitional fake joint. Many patients have felt significantly better once this has been removed. Other treatment options have been reported, including fusing that region. But once again, the minimally invasive surgery has been successful and does not preclude further treatment in the future, if necessary.
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