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.
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.
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.
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.
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.
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Reviewed by: Dr. Christopher Good, MD, FACS.