Bertolotti Syndrome An Unusual Suspect in Low Back Pain

Bertolotti syndrome is something that has not been heard of when it comes to lower back pain, but diagnostic work has uncovered a common congenital condition. Back pain is experienced at some point by all of us. Around two-thirds of the population will develop low back pain in their life, and more than half will develop chronic low back pain or pain that has lasted more than six months. Low back pain can be challenging to find the root cause. Diagnostic work is required through  X-rays and MRIs. These tests identify a lesser-known cause of mechanical low back pain: Bertolotti syndrome.

Bertolotti Syndrome

This congenital condition’s name comes from Italian physician Mario Bertolotti. It is in 10 to 20 percent of the population —with or with no lower back pain. Bertolotti syndrome happens when the lumbosacral transitional vertebra is the last lumbar vertebra/LSTV. This vertebra and the sacrum become fused or create a false joint due to an enlarged transverse process.

These can be bony bumps on the vertebrae where muscles and ligaments attach to the lumbosacral transitional vertebra. When the LSTV and sacrum fuse together, known as sacralization or pseudo-joint, it does not generate pain. It’s just how an individual’s anatomy has been since birth. Only when it causes lower back pain that is it called Bertolotti syndrome.

Causes

Low back pain that leads to inflammation and reactive muscle spasms brought on from Bertolotti syndrome can be caused by:

1. Asymmetrical structures of the lumbar vertebrae. If the LSTV is fused to the sacrum and iliac bone, these are the wings of the pelvis, which can place unwanted stress on the sacroiliac joint, which can cause pain that is felt above the buttocks.
2. A pseudo-joint does not have the cushion or lubrication between the bones like real joints to absorb shock. This causes bone-on-bone grinding, which can be painful and lead to osteoarthritis. This can also generate added stress on the discs of the pseudo-joint.
3. Sacralization fusion can decrease the spine’s mobility. This can speed up the wear and tear of the vertebrae and shock absorbers of the intravertebral discs.
4. Added non-equal force/s on the muscle tissues that surround the lower back. This can be caused by the spine not being properly aligned, causing muscle imbalance/s and fatigue. Both sides of the back can be affected, but when tightness and muscle spasms in the low back and pelvis are present, it’s usually only on one side.

Symptoms

Most individuals usually never know they have a sacralization or pseudo-joint. These are often found accidentally from an X-ray for something unrelated. But symptoms can vary from person to person and usually appear in adulthood—in the 20s or 30s.

These include:

• Low back pain that is localized and does not spread/radiate down the legs
• Pain or discomfort in or around the sacroiliac joint
• Stiffness that comes out of nowhere or difficulty moving a certain way with pain present
• Symptoms improve once the individual sits or lays down

Diagnosis

Bertolotti syndrome can be diagnosed based on medical history, physical exam, and X-rays. A physical exam can include a recreation of the movement/s that triggered the pain/discomfort. An X-ray of the low back and pelvis will reveal any bony abnormalities.

Treatment

Bertolotti syndrome can be effectively managed with non-invasive treatments. These  include:

• Improperly and overdoing repetitive rotation/s and extension/s through work or movements that have become second nature are injuries waiting to happen. Lifestyle changes and re-learning how to move properly will ease the strain on the affected area.
• Over-the-counter pain medication/s like Advil, Aleve, or Tylenol.
• Chiropractic/Physical therapy can help build low back areas and increase mobility.
• Local anesthetic and spaced out intervals of corticosteroid injections to the affected nerve/s to reduce inflammation.
• Platelet-rich plasma (PRP) uses the body’s platelets to reduce pain and inflammation and heal the damaged joints through an injection.
• Prolotherapy treatment uses concentrated local anesthetic and dextrose injected into the low back area to enhance the body’s natural healing.
• Radiofrequency ablation uses heat to numb the affected nerves around a pseudo-joint so that pain reduces.
• Surgery is the last resort and is usually done to eliminate a pseudo-joint. It can also consist of reducing or removing an elongated transverse process and can be performed as a same-day or outpatient procedure.

If you or someone you know is dealing with some form of idiopathic low back pain and doctors can’t seem to pinpoint the cause. Bertolotti syndrome could be a suspect; therefore, it’s best to seek a spine specialist near you that can help.

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