Bertolotti syndrome

Case contributed by Abdulmajid Bawazeer
Diagnosis almost certain


Persistent long standing left low back pain.

Patient Data

Age: 65 years
Gender: Male

There is transitional L5 vertebra with a left large transverse process which fuses with the sacrum forming a pseudo-articulation at that location. This could also be called hemi-sacralization of the L5 vertebra.

Grade 1 anterior spondylolisthesis of L4 over L5. Degenerative changes in the spine is noted.

Case Discussion

Bertolotti syndrome is common and affects 4-8% of the population with the classical presentation being chronic lower back pain.

Management includes fluoroscopically-guided steroid injection, radiofrequency ablation and surgical excision of the large transverse process.

This case is in keeping with type IIa LSTV according to Castellvi classification of lumbosacral vertebrae.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.