Korean J Pain.  2013 Oct;26(4):368-373. 10.3344/kjp.2013.26.4.368.

Bertolotti Syndrome: A Diagnostic and Management Dilemma for Pain Physicians

• Jain A
• Agarwal A
• Jain S
• Shamshery

• KMID: 2074045
• DOI: http://doi.org/10.3344/kjp.2013.26.4.368

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.

Keyword

Bertolotti's syndrome; low back pain; scoliosis

MeSH Terms

Back Pain
Humans
Intervertebral Disc Degeneration
Joints
Low Back Pain
Scoliosis
Spine
Zygapophyseal Joint

Figure

• 

  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 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 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.

Reference

1. Aihara T, Takahashi K, Ogasawara A, Itadera E, Ono Y, Moriya H. Intervertebral disc degeneration associated with lumbosacral transitional vertebrae: a clinical and anatomical study. J Bone Joint Surg Br. 2005; 87:687–691. PMID: 15855373.

2. Tae HS, Kim SD, Park JY, Kim SH, Lim DJ, Suh JK. Gray ramus communicans nerve block: a useful therapeutic adjuvant for painful osteoporotic vertebral compression fracture. J Korean Neurosurg Soc. 2003; 34:505–508.

3. Simopoulos TT, Malik AB, Sial KA, Elkersh M, Bajwa ZH. Radiofrequency lesioning of the L2 ramus communicans in managing discogenic low back pain. Pain Physician. 2005; 8:61–65. PMID: 16850044.

4. Manchikanti L, Helm S, Singh V, Benyamin RM, Datta S, Hayek SM, et al. An algorithmic approach for clinical management of chronic spinal pain. Pain Physician. 2009; 12:E225–E264. PMID: 19668283.

5. Henley C, Wollam K, Springs C. Sacroiliac pain: a physical therapy perspective. Post-Polio Health. 2006; 22:1–3.

6. Marks RC, Thulbourne T. Infiltration of anomalous lumbosacral articulations. Steroid and anesthetic injections in 10 back-pain patients. Acta Orthop Scand. 1991; 62:139–141. PMID: 1826584.

7. Santavirta S, Tallroth K, Ylinen P, Suoranta H. Surgical treatment of Bertolotti's syndrome. Follow-up of 16 patients. Arch Orthop Trauma Surg. 1993; 112:82–87. PMID: 8457417.

8. Nakamura SI, Takahashi K, Takahashi Y, Yamagata M, Moriya H. The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration. J Bone Joint Surg Br. 1996; 78:606–612. PMID: 8682829.