Weerakkody Y, Silverstone L, Walizai T, et al. Bertolotti syndrome. Reference article, Radiopaedia.org (Accessed on 27 Mar 2025) https://doi.org/10.53347/rID-24873
Although it may be a consideration in younger patients, the entity is considered controversial and has been both supported and disputed. Some studies suggest lumbosacral transitional vertebrae types II and IV positively correlate with the prevalence and severity of lower back pain and buttock pain 6.
Prevalence is estimated at ~5% (range 4-8%) of the population.
Radiographic features
Lumbosacral spine radiographs are usually sufficient for identifying this skeletal abnormality, however, can not definitively identify the transitional vertebrae as the source of pain. MRI is useful when radicular features with a prolapsed disc co-occur.
Treatment and prognosis
Some studies advocate surgical resection in selected refractory to more conservative approaches 8.
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History and etymology
The Italian radiologist MarioBertolotti (1876-1957) was the first to describe the syndrome in 1917 9.
1. Konin G & Walz D. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. AJNR Am J Neuroradiol. 2010;31(10):1778-86. doi:10.3174/ajnr.A2036 - Pubmed
2. Quinlan J, Duke D, Eustace S. Bertolotti's Syndrome. A Cause of Back Pain in Young People. J Bone Joint Surg Br. 2006;88(9):1183-6. doi:10.1302/0301-620X.88B9.17211 - Pubmed
4. Paraskevas G, Tzaveas A, Koutras G, Natsis K. Lumbosacral Transitional Vertebra Causing Bertolotti's Syndrome: A Case Report and Review of the Literature. Cases J. 2009;2(1):8320. doi:10.4076/1757-1626-2-8320 - Pubmed
5. Jain A, Agarwal A, Jain S, Shamshery C. Bertolotti Syndrome: A Diagnostic and Management Dilemma for Pain Physicians. Korean J Pain. 2013;26(4):368-73. doi:10.3344/kjp.2013.26.4.368 - Pubmed
6. Nardo L, Alizai H, Virayavanich W et al. Lumbosacral Transitional Vertebrae: Association with Low Back Pain. Radiology. 2012;265(2):497-503. doi:10.1148/radiol.12112747 - Pubmed
7. Li Y, Lubelski D, Abdullah K, Mroz T, Steinmetz M. Minimally Invasive Tubular Resection of the Anomalous Transverse Process in Patients with Bertolotti's Syndrome: Presented at the 2013 Joint Spine Section Meeting: Clinical Article. J Neurosurg Spine. 2014;20(3):283-90. doi:10.3171/2013.11.SPINE13132 - Pubmed
8. Jancuska J, Spivak J, Bendo J. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome. Int J Spine Surg. 2015;9:42. doi:10.14444/2042 - Pubmed
9. Lupo M. [Prof. Mario Bertolotti]. Minerva Med. 1958;49(37):Varia, 840-6. - Pubmed
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