What is the purpose of the steroid injections for Bertolotti’s syndrome?

Steroid injections can be helpful with providing longer lasting pain relief than medications. The pain people experience from Bertolotti’s Syndrome is due to the transverse process of the transitional vertebrae rubbing against the pelvis bone. With repetitive rubbing from daily activities, it can cause irritation and inflammation leading to pain. This is similar to arthritis in your joints. As your bones keep rubbing on each other, it becomes irritated, inflamed and painful. The administered steroid injection calms down the inflammation and as a result, provides pain relief.

Can Bertolotti's Syndrome cause “sciatic” pain?

Bertolotti’s Syndrome does not cause “sciatic” pain. However, Bertolotti’s Syndrome can cause premature degeneration of the discs and vertebrae in your lumbar spine which as a result may cause disc degeneration, herniation or nerve irritation.

What are the long term effects of untreated Bertolotti’s Syndrome?

If you are experiencing low back pain that has not improved with adequate time, rest or over the counter anti-inflammatories, give us a call! Let us help you return to a pain-free life!

What type of imaging is used to identify Bertolotti’s syndrome?

X-rays of your low back/pelvis is the most common imaging technique used to identify Bertolotti’s Syndrome. When looking at the x-rays, we are looking for an enlarged transverse process on the transitional vertebrae (usually L5, the lowest lumbar vertebrae). Sometimes though, if the x-rays are not clear enough, we may order a CT scan of your low back/pelvis to better assess the bony anatomy and to rule out any other pathologies that may be contributing to the pain such as sacroiliitis.

Bertolotti's Syndrome

UNDERSTANDING THE SYMPTOMS, CAUSES AND TREATMENTS

Understanding Bertolotti's Syndrome

Bertolotti syndrome, also known as lumbosacral transitional vertebra (LSTV), is a congenital disorder that often manifests as chronic back pain along the waistline. It occurs when the transverse process(es) of the fifth lumbar vertebra articulates with the sacrum, resulting in abnormal spinal mobility and associated discomfort. This condition is characterized by an irregular vertebral structure and can be a source of ongoing pain and discomfort for affected individuals. Often confused with sacroiliitis, this diagnosis affects less than 10% of the population and because of this it often goes undiagnosed. Bertolotti’s syndrome is a rare cause of back pain and can be treated by a qualified spinal specialist with modern spinal healthcare.

Causes of Bertolotti's Syndrome

During our spinal development, vertebrae located in the sacral region fuse together to form one bone called the sacrum. The sacrum is located in the region of the pelvis. In the low back or lumbar spine, lumbar vertebral bodies develop as separate segments with their own discs, transverse processes, spinous processes. Having these separate and vertebral bodies allow for range of 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. A transitional vertebrae transverse process is typically enlarged and often looks like a fake joint which 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.

Symptoms of Bertolotti's Syndrome

Patients diagnosed with Bertolotti’s Syndrome, or the transitional vertebra, often do not experience any symptoms. However, for the patients that do, they typically experience low back pain that radiates from the sides of their waistline. The pain may be thought as sacroiliac joint pain or lumbar disc or lumbar facet joint pain. This is why the condition is often misdiagnosed.

Diagnosing Bertolotti's Syndrome

Since Bertolotti’s Syndrome is often misdiagnosed, it is important to rule out the other causes of back pain to include pain related to the lumbar disc, pain related to the lumbar facet joints and degenerative disc disease, and even pain related to the sacroiliac joint. During your initial consultation you will undergo a thorough health history and comprehensive physical exam. Your spine specialist may require specific diagnostic imaging or diagnostic injections to rule out these other pain generators and locate the source of pain or dysfunction.

Treatment Options

For those patients that experience low back pain related to Bertolotti’s Syndrome, the first approach is to try non-surgical treatments. Spine-specialized physical therapy helps with mobilization, core strengthening, and stretching. Other options include steroid injections, radiofrequency ablation, and regenerative treatments such as prolotherapy and platelet rich plasma (PRP).

For some patients surgical intervention may be necessary. Minimally invasive spine surgery can reshape the enlarged transverse process and remove this transitional fake joint. Our patients have felt significant relief once this has been removed. Other treatment options have been reported, including fusing that region with a spinal fusion.