Presentation
Chronic low back pain that gets worse while practicing sports.
Patient Data
Transitional anatomy with what appears to be partial lumbarization of S1. Images show a psuedoarthrosis between the right transverse process of S1 vertebra and the sacral ala. Left sacroiliac joint is mildly narrowed.
Case Discussion
Classic imaging findings of lumbosacral transitional vertebra (LSTV), presumably causing Bertolotti syndrome.
Plain radiographs are enough for the identification of a lumbosacral transitional vertebra. However, if there is no chest x-ray available for counting the number of rib pairs or pelvic CT for locating the level of iliolumbar ligaments, one cannot confidently determine whether the transitional vertebra is a lumbarized S1 vertebra or sacralized L5 vertebra. Moreover, disc prolapse as a possible cause of low back pain and other soft tissue findings cannot be identified on x-ray and necessitate cross-sectional imaging, preferably MRI. Most cases of Bertolotti syndrome occur in young patients.