Bertolotti’s Syndrome (BS) is rare — with research showing it affects just 4–8% of the population. But it’s something we are both very familiar with as spine surgeons because it’s a cause of low back pain in young patients.
Word of mouth referrals are strong among those who have Bertolotti’s because knowledge about the condition isn’t as common as you would like. So we find that when people come to see us, we’re often a stop at the end of a very long road. The good news is — there’s lots that can be done to address and remove the terrible pain the syndrome causes and get these young patients back to living the pain-free lives they love.
Here are two case studies of recent patients of ours — showcasing both non-operative and surgical solutions for this syndrome.
18-year old Maggie Lang is an incredibly talented cheerleader from South Carolina with no fear when it comes to her sport. She started tumbling at 5 and has long been competing at a high level doing challenging stunts and flips and serving as the flyer — being thrown as much as 20 feet in the air. She loved everything about it — until the pain started in the winter of her junior year in high school.
“I couldn’t sit for more than 20 minutes without my leg feeling like it was on fire. I couldn’t bend over or sit. My hip hurt a lot and I couldn’t sleep because my right leg was throbbing all the time,” she recalls.
She stopped cheering for 3 months thinking the problem was her hip but in March 2022, doctors visits led her to the diagnosis of Bertolotti Syndrome — an extra transitional vertebrae on her lower spine was sitting on her sciatica nerve. Injections helped some but after several months, the pain was still present and getting in the way of her life and cheer.
She searched online for help and found that I have helped many patients with Bertolotti Syndrome so she and her mom flew up to see me. Upon seeing her, we decided surgery to remove the extra vertebrae was the best course of action for her because it would remove her pain and let her get back to the sport she loves.
She had the procedure in the fall of 2022 and says she took it easy for a week after the procedure. She started feeling better quickly after that and amazingly, was tumbling again in two weeks, back to stunting with her cheer team after three weeks and healthy and ready to try out for college cheer when the time came. She made it onto the team of course and is now headed to Clemson as a cheerleader. Most importantly, when she cheers — she no longer has the debilitating pain that plagued her for a very long time.
“She would never have been able to try out for Clemson cheer without that surgery,” her mom Ann says. “I wish I had gotten in touch with VSI sooner so she could have enjoyed her senior season and not been in pain for a whole year. But I’m just happy she finally did get the help. She has a lot to look forward to now.”
Anna Greer started having back pain when she was 16. The diagnosis of Bertolotti Syndrome came quickly for her — by the age of 17. But treatment to address her debilitating pain took a lot longer to find.
Anna was a junior in high school when the pain flare ups started. They ranged from a 3 to a 9 on a 1–10 pain scale and as a result, she was able to play volleyball, do competitive dance and exercise with Cross Fit as the pain ebbed and flowed. She took a gap year, didn’t work and says she mostly lay on the couch. In time she started to feel better so she was hopeful when she headed off to the University of Alabama for college. But in the Fall semester of her second year, the pain at the bottom of her spine near her waistline stretched down to her hips and got so extreme, she couldn’t sit in class or to study. Walking to class was a challenge. Taking the bus was painful. She just couldn’t function or focus on her school work and so she medically withdrew.
She went to doctor after doctor — not only near her Alabama home but traveling to see experts in Franklin and Nashville, TN and Birmingham, AL. She had phone consultations with many more. She says everyone told her the same thing — there’s nothing we can do for you. Anna and her parents weren’t willing to accept that. So in the spring of 2022, she and her Mom flew to Reston, Virginia to meet me — and I knew as soon as I saw her that there were in fact treatments that would help.
I didn’t see surgery as a good option for her and instead suggested stem cell regeneration so we could use her own stem cells to regenerate healing. She liked that idea and came back in April 2022 for the procedure. She was in and out the same day. I warned her relief wouldn’t be imminent. It takes time for stem cells to regenerate. But I was optimistic she would see a change in a few months and she did.
“I’ve had a lot of injections in my back and this hurt but I was in and out the same day and it wasn’t anything I couldn’t handle,” Anna recalls. Within two weeks, the pain subsided and in about four months, she remembers one day feeling excited. “I started to have pain relief. I felt so much better I started looking into returning to school and work.” By March 2023, she says she was 99% back to normal. She returned to school to study engineering and started working as a bartender and server — a job that keeps her on her feet for hours at a time. “Now I just have normal-people pain if I work a double shift,” she says with a smile. “I feel really good.”
Anna, now 21, says her advice to others with Bertolotti Syndrome is to have a good support system — for her it was her parents. She urges young patients to keep searching until you find the right doctor to help you. “Sometimes, because of my age, people didn’t believe me when I said how much pain I was in. Keep pushing to find people who will listen, acknowledge and believe you about your pain,” she says.
She says it’s also important to never give up hope. “There were days I thought the pain would last forever but it doesn’t have to. You will go through some hard times and it will be difficult watching your young friends live their normal lives but being young will ultimately help you heal faster.”
Dr. Colin Haines is a board certified spine surgeon and the Director of Research at Virginia Spine Institute. Dr. Haines performed the world’s first combined endoscopic and robot-guided spine surgery. His patient success has earned him a national feature on The Today Show and WebMD, and Top Doctor recognition in consecutive years. Learn more about Dr. Haines.
Dr. Niteesh Bharara is a world-renowned, double board certified orthopedic physician specializing in non-surgical sports medicine. He serves as the Director of Regenerative Medicine at Virginia Spine Institute and leads the Mid-Atlantic region in performing effective natural therapies such as stem cell therapy, platelet-rich plasma (PRP), prolotherapy, and adipose injections. Dr. Bharara’s distinguished expertise within this field earned him 2022 Face of Regenerative Medicine, and Top Doctor recognition in consecutive years. Learn more about Dr. Bharara.
Reviewed by: Dr. Colin Haines, MD.