Session Information
Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Nirguna Thalla, MD: No financial relationships or conflicts of interest
Case Diagnosis: A 19 year old male patient with no past medical history diagnosed with Bertolotti’s Syndrome.
Case Description: Our patient is a 19 year old previously healthy male that presents with right sided low back/ buttock pain of insidious onset over the past 5 years. His pain got progressively worse over the span of several months while participating in wrestling and his symptoms were significantly limiting his activities. This prompted a clinic visit during which he described a constant pain aggravated by activity and improved by rest. Examination revealed tenderness of the right PSIS and spasms of the lumbar paraspinals and gluteus medius. Further imaging revealed a transitional vertebra with transverse process pseudoarthrosis on the right most consistent with partial lumbarization of S1 as the likely source of the pain. Treatment consisted of a comprehensive rehabilitation approach including an L5 transverse process/sacrum pseudoarthrosis injection, physical therapy emphasizing strength/range of motion and scheduled NSAIDs for pain relief.
Setting: Outpatient Physiatry ClinicAssessment/
Results: At one month follow up, he completed multiple therapy sessions and received his injection. He noted significant improvement in pain and function. Previously stating a constant pain level of 5+/10, now improved to 2/10 and intermittent. His activity tolerance improved and he returned to sports related exercise.
Discussion: Bertolotti’s Syndrome (BS) is an important cause of low back in adults, diagnosed in only 4-8% of the population with low back pain. BS is a congenital condition that typically does not manifest symptoms till the patient is in their late twenties to thirties. This is a unique case of a younger than expected patient who also does not have a history of scoliosis, which is highly associated with BS.
Conclusion: Bertolotti’s Syndrome, an uncommon source of back pain, can have atypical presentations. A comprehensive rehabilitative approach can result in clinical improvement for these patients.
Level of Evidence: Level V
To cite this abstract in AMA style:
Thalla N, Heckman T, Sharma A, Batal HS. Dynamic Treatment Approach for Insidious Low Back Pain Presenting as Bertolotti’s Syndrome in a Young Patient: A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/dynamic-treatment-approach-for-insidious-low-back-pain-presenting-as-bertolottis-syndrome-in-a-young-patient-a-case-report/. Accessed May 31, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dynamic-treatment-approach-for-insidious-low-back-pain-presenting-as-bertolottis-syndrome-in-a-young-patient-a-case-report/