How do I know if I have Bertolotti’s Syndrome?

What are the symptoms of Bertolotti’s syndrome?

The presentation of Bertolotti’s syndrome is very broad, with symptoms that can mimic a herniated disc, result in back pain, or even hip or sacroiliac pain.

This overlap of symptoms with other, more common and generally understood conditions means that Bertolotti’s syndrome is often overlooked as a cause of a patient’s pain.

What causes Bertolotti’s syndrome?

Bertolotti’s results from a combination of factors: those affected will have a congenital anomaly known as a lumbosacral transitional vertebra (LSTV) as well as degeneration in the discs or a scoliosis that results in worsening the biomechanics of the spine at the level of the congenital anomaly.

An LSTV is incomplete formation of the spine at the junction of the sacrum and the L5 vertebral body. When there is interface between the transverse process of L5 and the top of the ala of the sacrum, the bone is left to rub against the bone. This is painful in and of itself, but can also result in inflammation that can irritate the L5 nerve which runs past the point of interface, causing further deformity or inflammation of the nerve and, consequently, more pain.

How is Bertolotti’s syndrome diagnosed?

Not every patient with a congenital anomaly of an LSTV will be diagnosed with Bertolotti’s syndrome. By using a combination of a patient evaluation and MRI or X-ray imaging, Dr. Jenkins can identify the true cause of pain and discomfort.

If imaging indicates an interface that implies Bertolotti’s, Dr. Jenkins can perform diagnostic injections directly at the transverse ala junction. If the typical pain is alleviated by the injections, then the diagnosis of Bertolotti’s can be confirmed. But, it is not uncommon for patients to have arthritic degeneration in discs, facet joints, scoliosis, and other conditions that may be the primary pain generator and the LSTV is not, which is why performing the diagnostic injections is so important.

Due to the complicated nature of this condition, the diagnosis needs to be done by a physician who is experienced with the symptoms of Bertolotti’s syndrome. Dr. Jenkins and Jenkins NeuroSpine have been studying the issue, and recently published academic research to help other physicians understand how to use imaging to see the congenital anomalies that cause these symptoms.


How is Bertolotti’s syndrome treated?

Traditional conservative management of Bertolotti’s syndrome consists of injections for pain management and physical therapy. If these methods don’t result in a reduction of symptoms, many physicians will turn to challenging open surgeries. There are two types of surgical procedures that can be done to treat patients for whom their Bertolotti’s is not responding to non-surgical interventions: decompressions (or resections, or reductions, depending on the term used) and fusions. Fusions eliminate movement at the level in question, while decompressions involve shrinking the bones down to a point where they should no longer come in contact with each other.

Dr. Jenkins, as a pioneer in this area, has developed a minimally-invasive outpatient procedure for each of the two types of procedures, to treat Bertolotti’s. There are a number of ways that patients with Bertolotti’s Syndrome have different anatomy from normal, and these specific procedures take those differences into account to ensure the best possible outcome for his patients.

In the “decompression” or “resection” procedure, Dr. Jenkins will trim down both the sacrum and the L5 transverse process on the affected side (or both sides, if appropriate) so the two bones don’t come into contact with each other anymore. For the fusion procedures, he uses two small incisions, on on each side, to place a combination of bone graft and pedicle screws, specific to the patient’s anatomy, to permanently eliminate the movement at the level that is causing pain.

His selection as to which procedure is best for each specific patient depends on many factors, including a detailed analysis of the biomechanics of each patient’s spinal anatomy, as well as their clinical symptoms and history. He has presented this methodology at international meetings and is continuing to study and report on the treatments so that each patient receives the best care for their unique circumstance.