When Back Pain Has a Name: Solving Bertolotti Syndrome

Key Facts

• Patient Testimony of Libbi, who traveled from Mississippi to VSI in Reston, Virginia
• She lived with severe low back pain for three and a half years before a correct diagnosis
• Dr. Colin Haines found Bertolotti syndrome that had progressed to two neighboring levels
• Libbi had a multi-level lumbar fusion in November 2025 to stabilize her spine
• Six months later: Libbi is playing tennis, walked 15,000 steps a day in Paris, and has no back pain

For years, Libbi Logan planned her life around calculating her next move and how it would impact her pain. If she went to her son’s game tonight, could she work tomorrow? If she played tennis, what would it cost her afterward?

Today she is back to being active and doesn’t have to plan her day around her pain, but getting there took three and a half years.

Watch her in the Get Back to Your Life™ Podcast Below:

Why Is Bertolotti Syndrome So Often Misdiagnosed?

Because finding an extra bony structure is common and the pain associated is not as common, it often gets ignored.

Bertolotti syndrome is extra bone at the base of the spine, where the L5 transverse process grows toward the sacrum until the surfaces grind. Bone grinding on bone hurts anywhere in the body, Dr. Haines points out. But plenty of people carry the same anatomy and never feel it, which is why the link to a patient’s pain gets missed, including by spine surgeons.

Libbi’s chiropractor was the first to notice something unusual on an X-ray. He used the words transitional vertebra and said he would need to consult someone more experienced. She went searching and found a Bertolotti patient group on Facebook. “Everything that I read, as soon as I saw it, I thought, this sounds just like what I’ve been going through.”

She had a name but she still had no relief. The first specialist she saw looked at her MRI, told her nothing was physically wrong with her, and walked out of the room.

What Does Bertolotti Syndrome Pain Feel Like?

For Libbi it would not hold still. It moved between her lower back and her hip, worse on one side some days and the other side on others.

“This idea that it’s not just one place, and that it kind of spurs pain in other areas, is really what made me go, hm, [Bertolotti syndrome] sounds like what could be going on.”

That pattern sent every provider chasing the wrong target. Therapists treated her IT band. They treated her SI joint. She improved slightly wherever they worked, and the real problem remained unaddressed.

“Nobody’s getting to the root here,” she says.

Can Bertolotti Syndrome Get Worse Over Time?

It can, and Libbi’s case shows how. Dr. Haines calls it a domino effect. Once the Bertolotti level stiffens, the levels above absorb the stress and motion they were never built for.

“The Bertolotti’s being stiffer caused the next level to work harder. It wasn’t designed to work that hard, and it deteriorated, becoming painful.”

The surgeon Libbi saw before VSI recommended a fusion but could not say what it would fix. She asked how it would address her pain. He said it would not. She asked which part it would help. He said it was hard to know until they operated. Then he looked at his watch.

“Just because somebody went to medical school does not make them an expert in every single case that they encounter.”

What Are the Treatment Options for Bertolotti Syndrome?

Most patients begin with spine-specialized physical therapy and targeted injections. When those fail, the surgical path depends on how far things have progressed. If the false joint is the problem and the neighbors are healthy, a Bertolotti resection removes a small amount of bone to stop the grinding, and motion is preserved. “If I take that bone away, the symptoms go away,” Dr. Haines says.

Libbi was past that point, so her spine needed fusion across the degenerated levels. Before recommending it, Dr. Haines asked something no one had in three years: what did she want her life to look like?

Her answer was not a marathon. It was laundry, dishes, and getting the garbage can to the end of the driveway. The summer before, home alone, she had heard the truck coming and could not move the can. Together, Dr. Haines and Libbi decided that a multi-level spinal fusion surgery would be able to address her persistent back pain.

Watch Dr. Haines Explain Libbi’s Case:

What Is Recovery From Bertolotti Surgery Like?

Libbi had been quoted six months of recovery and three months off work by the surgeon she saw elsewhere. After she had multi-level spinal fusion surgery with VSI, the difference in her recovery was astounding.

She was walking within hours. She flew home to Mississippi eight days after surgery, and that Friday climbed a few bleacher rows to watch her son play basketball. “I sat there in less pain than I had been two weeks ago to watch a basketball game.”

At one month, cleared to bake as long as she avoided bending, lifting, and twisting, she made roughly sixty pans of cinnamon rolls by New Year’s. In late January, she took the garbage can down herself, then flew to Phoenix alone. In March, she played tennis for the first time in over three years. In May, she spent eight and a half days in Paris with her sister.

“My feet gave out and my exhaustion gave out way before anything else. My back never bothered me.”

She still feels the hardware, not as pain but as awareness, and was told that can take up to a year to settle.

“I literally every day get up and go, my back doesn’t hurt.”

Libbi after multi-level spinal fusion

How Do You Find a Bertolotti Syndrome Specialist?

Look for a surgeon who treats the condition often and examines the neighboring levels, not the extra bone alone. Libbi started with a virtual consultation from Mississippi. VSI treats patients nationally and internationally through a destination medicine program, and consultations can begin through telehealth.

Her own advice is simple. “Don’t give up. Keep searching.”

Frequently Asked Questions

Can Bertolotti syndrome show on an MRI without being the cause of your pain?

Yes. The same anatomy appears in people with no symptoms, so imaging confirms the finding rather than the pain source. Dr. Haines evaluates the discs above and the SI joints below before concluding. Dr. Haines explains how SI Joint pain is often associated with Bertolotti syndrome in this video.

What is the success rate of Bertolotti syndrome surgery?

Outcomes depend on which structures are generating pain and whether neighboring levels have broken down, so a single figure would mislead. Ask what result your surgeon expects in your case and why.

Finding the Answer to Your Back Pain

Libbi spent three and a half years being told there was nothing to find. The answer existed and finding it took someone willing to look past the obvious and truly take the time to learn about her symptoms.

If you are still searching, we are here when you are ready.