Bertolotti’s Syndrome

What is Bertolotti’s Syndrome?

Bertolotti’s syndrome is still a largely unrecognized congenital anomaly that causes pain in the lower back and legs.

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 scoliosis that results in worsening the biomechanics of the spine at the level of the congenital anomaly.

A LSTV is an incomplete formation of the spine at the junction of the sacrum and the L5 vertebral body. When there is an 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.

Dr. Jenkins was one of the first few doctors in the U.S. to bring Bertolotti’s syndrome to the forefront of current spinal diagnosis and treatment. He’s recognized for his ongoing clinical research, vast surgical experience, and commitment to patients worldwide.

Dr. Jenkins has conducted numerous surgeries and pioneered minimally invasive techniques. His in-depth study of long-term patient outcomes solidifies his position as the surgeon of choice for managing and understanding this condition effectively.

What are the Symptoms of Bertolotti’s Syndrome?

The presentation of Bertolotti’s syndrome is broad, with symptoms that can mimic a herniated disc, resulting 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. Bertolotti’s syndrome is also associated with other congenital conditions such as congenital cervical stenosis and Ehlers-Danlos Syndrome hypermobility type.

Not every patient with LSTV and back pain has Bertolotti’s syndrome. An expert is needed to recognize when a patient has pain caused by Bertolotti’s syndrome, when the pain is coming from a completely different spinal problem, or a combination of both. Whatever the case, surgical solutions are always tailored to the patient’s needs and performed in the safest possible manner, taking into consideration any existing medical conditions, and goals for the patient’s overall spinal health and lifestyle.

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. Two types of surgical procedures can be done to treat patients when Bertolotti’s syndrome is not responding to non-surgical interventions:
  • Decompressions (or resections, or reductions, depending on the term used) involve shrinking bones to a point where they no longer come in contact with each other.
  • Fusions eliminate movement at the level in question.

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 fusion procedures, Dr. Jenkins uses two small incisions, one 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.

As a pioneer in this area, Dr. Jenkins has developed minimally invasive outpatient options for both types of procedures. These treatments for Bertolotti’s allow most patients to go home from the hospital the very same day. There are several 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.