Bertolotti syndrome introduction Bertolotti’s Syndrome is defined as chronic low back pain caused by lumbosacral transitional vertebrae (LSTV).
Bertolotti syndrome introduction Bertolotti’s Syndrome is defined as chronic low back pain caused by lumbosacral transitional vertebrae (LSTV). In the spines of these patients, the enlargement of the caudal lumbar vertebrae at the transverse process leads to the fusion or articulation of the transverse process with the sacrum or the ilium, causing discogenic disease and limiting mobility. This is one of the diagnoses that are challenging due to the uncommon nature and variable presentation.
Although Bertolotti syndrome was first described nearly a century ago, the paucity of published literature of this rarely recognized anatomic variant has left uncertainty regarding its clinical significance and the optimal treatment of a symptomatic Bertolotti joint. Sports medicine and orthopedic providers should include this in cases of chronic low back pain. The pain caused by Bertolotti’s Syndrome is not uniform and originates from different pathology caused by the LSTV.
These pathologies include scoliosis, arthropathy of the joints, and muscle strains of the quadratus lumborum and iliopsoas. The deformation of the transitional vertebra may cause nerve compression due to compressed discs resulting in neuropathic pain. The pain reported on a daily basis is a significant intensity and can be very disabling.
Bertolotti’s Syndrome encompasses many types of LSTV that are defined under the Castellvi system, which was determined in 1984. These four types of LSTV include: Type I-dysplastic transverse process that is at least 19cm wide, Type II-transverse process growth leading to an incomplete sacralization or lumbarization of the transverse process, Type III-complete transverse process sacralization/lumbarization, and Type IV- mixed complete sacralization and incomplete sacralization. Of the Castellvi classifications, the most commonly seen LSTV is Type 1 (42%), followed by Type II (38%), Type III (8%), and Type IV (5%).
Disc herniations are often present at single levels, although some patients have herniations of multiple discs due to the lumbosacral transitional vertebra. Bertolotti’s syndrome has a very wide and debated incidence that spans from 4 percent to 36 percent. The biomechanics of LSTV is attributed to an alteration or reduction of movement between the transitional vertebra and the sacrum that can ultimately lead to pain from stress in the facet joint and/or is exacerbated by disc degeneration.
If you are experiencing symptoms that may be related to bertolotti syndrome, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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