Bertolotti’s Syndrome: An Underdiagnosed Cause of Lower Back Pain; A Case Report of Two Cases and Current Management Options

Bertolotti’s syndrome is a disorder of the spine characterized by chronic lower back pain associated with lumbosacral transitional vertebra (LSTV) in which there is an abnormal enlargement of the transverse process of the fifth lumbar vertebra. It may be a source of chronic pain in 10% of lower back pain patients younger than 30 years. In Bertolotti’s syndrome, the fifth lumbar vertebra transverse process may be enlarged either unilaterally or bilaterally and may articulate or fuse with the sacrum or ilium. It is an anatomical variant of sacralization of fifth lumbar vertebra. This causes alterations in the biomechanical characteristics of the lumbar spine resulting from asymmetrical motion between the sacrum and LSTV. It is often a factor that is not taken into consideration in the workup and management of lower back pain. The syndrome affects 4% to 8% of the population. It can cause pain due to involvement of various structures: lumbosacral neo-articulation, contralateral facet arthrosis, sciatica, discogenic, or sacroiliac pain. Physical examination usually shows normal findings. Bertolotti’s syndrome is oftentimes underdiagnosed and should be suspected as a differential diagnosis for lower back pain. Therefore, this case report highlights two cases with Bertolotti’s syndrome and explains its epidemiology, pathophysiology and management which is an important topic of general knowledge to all doctors.