Disclosures: David K. Jacobs, MD: Interventional Orthopedics Foundation: Other Financial or Material Support, Conference stipend recipient

Case Description: Bertolotti’s syndrome is classified as lower back pain due to a congenital anomaly that causes transitional vertebrae. This causes an articulation/bony fusion between the L5 transverse process and the sacrum. We present a case of Bertolotti’s syndrome treated with an interventional spine procedure after failing conservative management.

Setting: Acute care hospital

Patient: A 15-year-old female presented with over 2 years of non-radiating right lower back pain that started while running cross country. The pain was described as achy, dull, worse with activity and extension, and rated as a 7/10 on the Visual Analogue Scale. The pain was not in relation to her menstrual cycles and she denied numbness/tingling. On physical examination: neurovascularly intact in all extremities, tenderness to palpation over right lumbosacral junction, full range of motion, and negative Patrick’s test bilaterally.

Assessment/Results: MRI lumbosacral spine without contrast demonstrated a mild S-shaped curvature of the lower thoracic/lumbar spine and transitional anatomy at the lumbosacral junction with partial sacralization of the L5 vertebrae bilaterally with a right-sided L5-S1 assimilation joint present. The patient received minimal relief with a soft lumbar corset, physical therapy, or with acupuncture. The patient received an intra-articular injection with 2 mL of 1% lidocaine and 80 mg of methylprednisolone acetate between the right L5 transverse process and ilium under fluoroscopic guidance. After the injection, the patient’s pain decreased by over 50% and the patient was able to run pain-free.

Discussion: Bertolotti’s syndrome is an underdiagnosed cause of lower back pain in patients under 30 years old and its incidence in patients with lower back pain ranges from 4-7%. Beyond conservative treatment, interventional spine procedures or surgical management with either resection, lumbar spinal fusion, or surgical nerve decompression are therapeutic options.

Conclusion: More studies are needed to evaluate the long-term efficacy of interventional spine procedures vs. surgical management for patients with Bertolotti’s syndrome.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-15-year-old-female-cross-country-runner-with-bertolottis-syndrome-treated-with-an-intra-articular-injection-at-the-pseudoarticulation-site/