Definition: Bertolotti syndrome is one of the causes of back pain caused by the presence of a lumbosacral transitional vertebra (LSTV), which is characterized by enlargement of transverse process(es), with potential neoarticulation or fusion with the sacrum.The disc at the level of the transitional segment is often rudimentary, with little nuclear material; disc herniations seldom occur at this level. Rather, stresses may be accentuated at the supra-adjacent disc level, where accelerated disc degeneration and an increased incidence of disc herniations have been reported.
Symptoms: It can cause low backpain due to involvement of various structures: lumbosacral neoarticulation, contralateral facet arthrosis, discogenic or sacroiliac pain.
Axial low back pain in the presence of an asymmetric transitional segment has also been attributed to abnormal unbalanced motion at this level, with the neoarticulation of the transverse process with the sacral ala or the contralateral facet as the specific pain generator.
Incidence of Bertolotti syndrome is high according to some studies ( between 4% and 32% ).
Diagnosis: Physical examination is usually normal. Diagnosis is by XRay, CT Scan or MRI.
Management: Initial management is conservative with NSAIDs, exercises and lifestyle modifications. Interventional procedures like local anaesthesia and steroid injection into neoarticulation, under fluoroscopy guidance can relieve pain. Surgical resection of the neoarticulation gives complete relief of pain.
Conclusion: Bertolotti syndrome bacause of LSTV may thus be associated with axial pain, related to neoarticulation, the contralateral facet at the level of an asymmetric neoarticulation, or Internal Disc Disruption ( IDD ) in the at risk disc above a transitional segment. Radicular pain may be caused by a herniation in the adjacent segment disc or an extraforaminal entrapment at a neoarticulation.
