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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.

WHAT IS A TRANSITIONAL VERTEBRA?

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.

DOES A TRANSITIONAL VERTEBRAE PRESENT SYMPTOMS?

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.

TREATMENT FOR BERTOLOTTI’S SYNDROME

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.

Virginia Spine Institute’s reputation is unmatched as a world-renowned luxury destination in spinal healthcare, dedicated to providing an elevated level of concierge care for those suffering from neck and back conditions. For three decades, their proven methods have led them to dramatically improving the quality of life for over 100,000 patients, from 32 countries.

People seek care from Virginia Spine Institute because of their elite team of board-certified spine-specialized physicians offering unique approaches to safe and effective back and neck pain relief. As one of the few centers that begin treatment with non-surgical options before recommending surgery, 90% of their patients get better without spine surgery. Through a comprehensive model, Virginia Spine Institute is able to offer regenerative medicine, non-operative treatments, minimally-invasive spine surgery, and physical therapy through their team of spine specialists.

The team’s dedication to detail and patient success is a shining light in the field of spinal healthcare. As pioneers and leaders in this field, they have also accomplished many of the world’s firsts in spine surgery by using modern treatments and cutting-edge technology not offered anywhere else.

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