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Orthopedics

Bertolotti Syndrome

Bertolotti syndrome is a congenital disorder leading to back pain associated due to a lumbosacral transitional vertebra (LSTV). It most frequently occurs via an articulation of the L5 vertebra transverse process(es) with the sacrum, leading to irregular spinal mobility and pain. This disorder affects up to 8% of the population and must be accurately diagnosed to be managed appropriately. This activity describes the evaluation and treatment of Bertolotti syndrome and reviews the role of the inter

v1 · Reviewed Nov 8, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Lower back pain unrelieved by conservative measures and in the presence of sudden weight loss/gain, intractable night pain, and otherwise unexplained should raise suspicion for a primary or malignant tumor of the lumbar spine/sacrum/pelvis.
  • Imaging is imperative for the accurate diagnosis of Bertolotti syndrome.
  • Plain radiographs of the lumbar spine and pelvis can generally provide ample diagnostic information to show lumbosacral transitional vertebrae.
  • A Ferguson radiograph, which is an AP view of the lumbosacral junction with 30 degrees of cephalad angulation, may be particularly helpful.
  • Advanced imaging in the form of computed tomography (CT) can delineate the lumbosacral junction in greater detail than plain radiographs, especially in patients with greater body habitus, which may obscure the imaging.
  • Magnetic resonance imaging (MRI) is useful for identifying other lumbar pathologies, including degenerative lumbar intervertebral discs along with disc herniations/annular tears/fissures, as well as areas of sites of neural stenosis.
  • CT and MRI can also help with vertebral numbering, which may not be apparent on plain radiographs and are critical for treatment planning.
  • Additionally, if the patient is experiencing any degree of radicular symptoms, an electromyogram (EMG) of the lower extremities may be obtained to help diagnose lumbar radiculopathies versus peripheral neuropathies.
  • Initial management of Bertolotti syndrome should consist of conservative measures.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may provide significant relief, are low in cost, and are generally well tolerated.
  • Physical therapy (PT) may also be concomitantly recommended at the time of diagnosis, with treatments aimed to strengthen core musculature, improve spinal mobility, and provide other pain-minimizing modalities.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
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  • If NSAIDs and PT fail to provide adequate relief, the patient may be recommended for injection therapy.
  • Directed corticosteroid injections under fluoroscopic guidance into the abnormal articulation are highly effective in providing pain relief and may last temporarily, if not indefinitely.
  • Surgery is reserved for individuals who have failed these aforementioned conservative approaches.
  • Resection of the enlarged transverse process involved in the LSTV, either unilateral or bilateral, can be an initial surgical option if the pseudo articulation has been determined to be the definitive etiology of pain.
  • If instability is present at the L5-S1 segment, spinal fusion may be indicated.
  • A decompressive operation may also be indicated if there is a symptomatic central canal or foraminal stenosis present.
  • The LSTV of Bertolotti syndrome is a nidus for abnormal mobility and mechanics of the spine.
  • Consequently, greater stress is typically dispersed onto the adjacent segments of motion.
  • These increased forces that the adjacent segment experiences are at risk for accelerated disc and facet joint degeneration, arthrosis, and, ultimately, neural stenosis.
  • As with all surgical procedures, there is a risk of bleeding at the surgical site, infection, and the need for the patient to have future operations if the first was unsuccessful.
  • These procedures also risk nerve injury due to the surgery’s proximity to the nerve root canal and the spinal cord.
  • Although surgical complications are rare, it is imperative to discuss these with the patient.
  • Patients should be informed of any abnormal connections or anatomy within the spine as soon as it is identified and should be counseled on how that may affect their mobility and quality of life.
  • review
    Bertolotti Syndrome. StatPearls [Internet] — Amanda E. Miller, Andrew Zhang — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov