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. 2013 Oct;26(4):368-73.
doi: 10.3344/kjp.2013.26.4.368. Epub 2013 Oct 2.

Bertolotti syndrome: a diagnostic and management dilemma for pain physicians

Anuj Jain  1 , Anil Agarwal, Suruchi Jain, Chetna Shamshery
Affiliations

Bertolotti syndrome: a diagnostic and management dilemma for pain physicians

Anuj Jain et al. Korean J Pain. 2013 Oct.

Abstract

Background: Bertolotti's syndrome (BS), a form of lumbago in lumbosacral transitional vertebrae, is an important cause of low back pain in young patients. The purpose of this study was to assess the etiology of low back pain and the efficacy of treatment offered to patients with BS.

Methods: All patients of BS Castellvi type1a during a period of 6 months were enrolled in the study. The patients underwent interventional pain procedures for diagnosis and pain relief. Response to the therapy was assessed based on VAS and ODI scores. A 50% decrease in VAS score or a VAS score less than 3 would be considered adequate pain relief.

Results: All 20 patients diagnosed with BS during the 6-month observation period had scoliosis. Common causes of back pain were the ipsilateral L5-S1 facet joint, neoarticulation, the SI joint, and disc degeneration. Responses to various interventions for pain relief were different and inconsistent from patient to patient. In particular, responses to interventions for neoarticular pain were generally poor.

Conclusions: Pain in patients with BS does not usually respond to interventional pain treatment. A very dynamic treatment approach must be pursued while managing BS patients, and the treatment plan must be individualized at various stages in order to obtain satisfactory pain relief.

Keywords: Bertolotti's syndrome; low back pain; scoliosis.

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Figures

Fig. 1
Fig. 1
Graphical presentation of the Oswestry disability scores over the follow-up period. The patients showed improvement in disability and shifted from a higher disability category to lower one.
Fig. 2
Fig. 2
Graphical presentation of the severity of pain on VAS during follow-up of the patients. Patients were sorted into groups based on the Oswestry disability index.
Fig. 3
Fig. 3
SPECT/CT image of a patient of Bertolotti syndrome revealing Scoliosis. Increased tracer uptake at the left L4-5 and L5S1 facet joint and at left sacroiliac joint suggestive of inflammatory pathology at the respective sites.
See this image and copyright information in PMC

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