Services 2 — Palomar Spine and Pain

Bertolotti Syndrome Injection

Bertolotti's Syndrome is a condition that can be an unexpected source of axial low back pain and discomfort.

Understanding Bertolotti Syndrome

What Is Bertolotti's Syndrome?

Bertolotti's syndrome is characterized by an uncommon cause of axial low back pain or buttock pain. It is primarily caused by a transitional lumbar vertebra with a unique, "spatulated" transverse process. This process can exhibit one of two scenarios: it either fuses with the sacrum (sacral ala) or the ilium, or it forms a pseudo-articulation at that location. In cases where it fuses with the sacrum, it may also be referred to as hemi-sacralization of the L5 vertebrae.

This condition is congenital but often remains asymptomatic until a patient reaches their 20s or 30s.

The Source of Pain

The pseudoarticulation or fusion site can be the origin of discomfort, resulting in axial low back pain. Alternatively, when the junction fuses, it can transmit forces to the sacroiliac joint (SIJ), leading to pain in that area.

For individuals with clinical presentations suggestive of sacroiliac joint disorder or pain that persists despite physical therapy and fluoroscopic intra-articular injections of the sacroiliac joint, it's important to consider the possibility of Bertolotti's Syndrome. A thorough evaluation, including AP X-rays of the lumbar spine, can be instrumental in diagnosis.

Fusion of the transverse process may also limit movement unilaterally at the L5/S1 level. This can cause increased movement on the opposite side or even result in L5/S1 or L4/5 disc herniation, leading to radiculopathy.

Treatment Options

Managing Bertolotti's Syndrome can involve various approaches, including:

Fluoroscopically-Guided Injections: Steroid injections and local anesthetic blocks at the pseudoarticulation site can offer relief.
Radiofrequency Ablation: Thermal ablation along the articulation can be considered to alleviate discomfort.
Surgical Intervention: In some cases, surgical excision of the large transverse process may be necessary for long-term relief.

At Palomar Spine & Pain, our team of experts are well-equipped to diagnose and manage Bertolotti's Syndrome. If you or a loved one is experiencing persistent back pain and suspect this condition may be the cause, please reach out to our experienced medical professionals for a comprehensive evaluation and personalized treatment options.

Don't let Bertolotti's Syndrome hold you back from living life to the fullest. Contact us today to schedule an appointment and take the first step towards a pain-free future.

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