Case study 44 - Bertolotti's syndrome - DIAGNOSIS and TREATMENT explained by a neurosurgeon

Case study 44 - Bertolotti’s Syndrome is defined as chronic back pain caused by transitional lumbosacral vertebra. The transitional vertebra may present with numerous clinical manifestations leading to a myriad of associated pain types. The most common is pain in the sacroiliac joint, groin, and hip region and may or may not be associated with radiculopathy. Diagnosis is made through a combination of clinical presentations and imaging studies and falls into one of four types. The incidence of transitional vertebra has a reported incidence between 4 and 36%; however, Bertolotti’s Syndrome is only diagnosed when the cause of pain is attributed to this transitional anatomy. Therefore, the actual incidence is difficult to determine.
Initial management with conservative treatment includes medical management and physical therapy. Injection therapy has been established as an effective second line. Epidural steroid injection at the level of the transitional articulation is effective, with either local anesthetics alone or in combination with steroids. Surgery carries higher risks and is reserved for patients failing previous lines of treatment. Options include surgical removal of the transitional segment, decompression of stenosed foramina, and spinal fusion. Recent evidence suggests that radiofrequency ablation (RFA) around the transitional segment may also provide relief.
There are surgical options to treat Bertolotti’s Syndrome. Although an effective method of treatment when indicated, there are inherent risks with surgery. One of the most common forms of treatment is resection, also known as the “Processectomy,” of the lumbosacral transitional vertebra. This surgery addresses back pain in a patient with LSTV related to the mechanical stress of the pseudo articulation or the articulation.
A spine fusion is a surgical procedure that helps relieve the chronic pain caused by Bertolotti’s Syndrome. A study by Santavirta followed eight patients who underwent a resection of the transverse process and eight who underwent a posterolateral fusion. When comparing the long-term outcomes, the fusion cohort had an increased disc degeneration in the disc immediately superior to the fusion, with 7 of 8 patients showing degeneration at follow-up. However, patients with previous disc degeneration of the LSTV disc, but not the superior disc, fared better with the fusion than the resection. As such, it is recommended that fusion be considered on selected patients who have previous disc pathology.
#neurosurgery #neurosurgeon #casestudy #bertolottissyndrome #bertolottis #learnonyoutube #surgery #spinesurgery #backpain #backsurgery #spinalstenosis #ladyspinedoc

[@rafa_zuri]

Same story here, all the way from Zurich, Switzerland. I was diagnosed yesterday and I'm hopeful my many years of pain could come to an end 🙌🙏

[@amandamiller7140]

I wish I were local to you. A chiro was the first to catch Bertolotti’s Syndrome and it sometimes feels like a lost cause. I feel too young to have this much pain but have trouble trusting doctors so I mostly try to work through things with PT and rest. It’s tough. I appreciate your videos!

[@susquahallasmiley3262]

Thank you for being a doc who works the problem-using evidence. The patient’s initial complaint followed by a rather clear x ray.

[@MusicFandom]

I was told I had this when I was 18 years old but have forgotten about it over the years (I am 49 now) but have lived with chronic pain for 30 years.. I have had 7 MRIs and at least that many xrays and nobody has mentioned it. My last mri report mentioned it but my Drs and even surgeons never brought it up. I have a lot of other issues and will list what the last mri report said. CERVICAL: * Broad based Bulging Discs at C2/3, C3/4 and C4/5 with narrowing of the spinal canal w/moderate neural foraminal narrowing * C5/6 Post ACDF Broad based bulge w/ moderate stenosis and moderate neural foraminal narrowing * C6/7 Post ACDF Broad based bulge w/ moderate stenosis and moderate to severe neural foraminal narrowing * C7/T1 Broad based bulge causing mild neural foraminal narrowing * Arthritis (DJD) at facet Joints C5-C7 LUMBAR: * L4/L5 Broad based bulge causing moderate stenosis and mild neural foraminal narrowing, posterior annular tear and DJD (Arthritis) * L5/S1 mild Neural foraminal narrowing and DJD (Arthritis) * Left sided transitional anatomy with articulation of the left L5 transverse process is present and this can contribute to low back pain.

[@kathleensmith8365]

Love this! What a great outcome. You listened, id not make assumptions, reviewed the facts, made a logical plan. This woman's whole life has been changed. Now that's a good day at work!

[@imane4989]

You are amazing 👏 I'm a neurosurgeon too and I recognize you easy way to explain things

[@jamieandrews5124]

I have this issue too. Doctor told me it not an issue, but I swear it is... I have multi other issues with my back too so may just be least of my issues. To me was very interesting finding. Glad I saw this... very helpful to better understand. Thank you!

[@Littleye2k2]

Yes, these doctors are so clueless. Especially disability doctors

[@sejalshah3954]

Thank you so much Dr. Grinch on posting this video!! You have helped me understand what my son may have. He is complaining of pain near the l5 s1 area. Thank you for performing this type of surgery to help patients!!🙏🙏

[@user-ve5nn3sq3t]

I have this, but for the past 5 years the doctors believed it was "somatic symptoms from stress". Love being 26 with my penguin walk 🤭

[@lilly_koii]

I have this too! it only affected my hip from age 16-24 so when that x-ray came back clear my doctor thought it was just due to bad sitting positions. then at 25 it started radiating down my leg and made the L5 area swollen lol. apparently I also have mild spina bifida too, my mom was like "oops I guess I should've taken vitamins back then" 😂

[@lz3923]

This was so cool!! I spotted the issue on the image but had no idea what we were looking at or what it was called. Great video!!

[@MahmoodSuhail]

I'm exactly like her! Been suffering with back pain for year and messing around with physical therapy, laminectomy in which they caused permanent tear un the annulus which is not healing, and not being able to sit for so long and tending to lay down most of the time to alleviate the pressure in my lower back caused me three painful herniated discs in my neck, I'm now not able to sit nor sleep! I don't have wings to flys and still being watched suffering without any solution! NSAID'S caused me to have psoriasis and Chron's disease. In a few months I turned from a person who's fully active and lifting weight to a disabled man crying of the pain like a child

[@deborahdufel1664]

And that's how it's done, ladies and gentlemen, a truly honest doctor. Thank you. Dr. Grunch

[@joannapeters2638]

Recently diagnosed with Bertolotti's syndrome.. when I saw where you pointed for her pain in the case study I nearly fell off my chair because you could have been pointing at my own back 🤯

[@billrogers3207]

I am going through this same issue. Have had the same surgery’s as the person in the video and still have the stabbing pain at the sacrum. Wish I could find a doctor to listen to me. Maybe I need to make a trip to Georgia.

[@lessehead]

If I were you, I absolutely would. As someone who has suffered with 38 yrs of chronic pain from degenerative disc disease and fibromyalgia, when you hear about a great dr, it’s worth going to them, at least for a consult. Good luck!

[@TheSUPERHAPPY1]

I love that you listened/heard/investigated

[@serenafuller1454]

I went to pain management for the first time, and my specialist pointed out an "accessory joint" located at my L5-S1 on my MRI scan. Having back pain for 5 years and learning this, it makes so much sense.. so many scans of mine pointed out "transitional lumbosacral anatomy" at my L5

[@hillarybarrett5939]

I want to thank you! This is exactly me! They are to the point where the 1st dr was pushing me to do the stimulator but he didn't even look at my tests, just flat said it was failed back surgery from over 6yrs ago, but this is not even remotely the same pain now! I'm officially getting a 2nd opinion with a new Dr!

[@DrBlack-no7gw]

Nicely explained doc

[@willbrooks8906]

I too have had wrong diagnoses with mine. It was finally spotted and the specialists said cbt was the only option to deal with the pain… thankfully after kicking up a fuss a spinal surgeon picked up my case and called me in for a consultation… he shown me my scans and explained everything to me,ensuring I comprehended each option and the extent of my condition. I now have a much better understanding of it. I’m awaiting cortisone injections to see if that helps with rf ablation to follow if it does not. Given the size and depth of my growth though he’s willing to operate if needed but would really like to avoid it as mine is larger than the L5 vertebrae itself and will be rather debilitating

[@hispeedtradingcompany3360]

Have you had any success for this?

[@willbrooks8906]

@@hispeedtradingcompany3360 not at all, I was in the midst of having the injection and took a bad turn... It did however bring to light a neurological issue that I didn't know about🤣 truth be told though I've been prescribed morphine and lots of other concoctions and the only kind of relief I can get is through medical thc

[@Thecatnamedkiwi]

I have this and I am In sooo much pain. I got diagnosed with it when I was 15. I'm 28 now and it's only gotten worse. Currently looking a spine doctor 😢 wish me luck

[@annmarieshrader3930]

HEY! I am an exercise physiologist and work at MAYO Clinic. I saw an orthopedist and he took xrays and did an mri of my hip. I now have tendonitis in my knee and hip and a partially torn hamstring. (I won't get into my knees - the hip issue might be a related cause). I had done some research and have suggested that this might be Bertolloti's. I had gone back to my Spine NP and for whatever reason she sent be back to the Orthopedic. I had related issues and sat down with him and had him go over the xrays which present similar to what you had in a previous video. Now, I am trying to get the spine clinic to address it, call it what it is (correct me if I am wrong) and suggest alternatives. I have been through therapy and other clinicians. Nice to see a ginger talk this topic. I know a bit about neurosurgery- I was a PCT on the hospital floor working that population- nights. (I didn't survive!) LOL

[@Collection-wu2hk]

In my case the radiologist caught it but it was labeled as "transitional lumbosacral anatomy" my doctor's didn't think anything about it. I was fed up one night and started going over all my scans and tests and realized I didn't know what half of the stuff was so between my sister's old medical books and google I figured it out and it lead them to discover a extra bone on the bottom of my hip too now I'm patiently impatiently waiting for a surgeon. Most of my doctor's never heard of it

[@nuttyirishman]

Loved your way of explaining this I've been dx'd with lumbarization of L6-S1. Ive got an amazing team of doctors but none of them can get on the same page as how to treat it. Im 46yrs old abd have had 7 spine surgeries since 1997. I also have hypermobile Ehlers-Danlos so I guess its a wee bit tricky. I just had 8 injections this morning which seems to be helping. I'm also a weathered realist and when it wears off the bone on bone pain is going to be bad...

[@ro-annbergstedt2907]

I experienced problems once a year with onset of winter. Terrible pain, can't sit for long , pain dissapears if I walk or stand. I am 53. Specialist in South Africa told me after having one look at my x-rays that I have BS. I was born with it. Started experiencing pain in my late 40's. Only thing that helps is actually walking every day, strengthening your core muscles and strengthening your back muscles. Specialist told me that operation was not an option. Meds don't help and I refuse to take painkillers.

[@lbmartinet]

Thank you! Just watched the full vid. Do you deal with full leg amputees and phantom pains and associated hip/back pain?

[@AJ-gz6qd]

I have horrible back pain, and every doctor tells me they only see LSTV( Lumbosacral Transitional Vertebrae)with partial sacralization, which they claim shouldn’t be giving me any problems. I have suffered tremendously due to this congenital anomaly and at age 51 it’s getting worse.

[@candace1103]

I have this too. Through my own research based off my mri reading I found out it is bertolottis. I am so tired of the pain and have had countless failed conservative attempts! I want the bone removal surgery! But none of the neuros in my hospital have ever even heard of the condition

[@Niemannsnuthouse]

I just came across Bertolotti's Syndrome. For 26 yrs I have had back issues after a fall while I was 8 mths pregnant. At 1st, I had to wait several mths after my delivery until my ligaments tightened back up b4 any imaging was done. So, I waited while in agonizing pain. However, I was also given the instructions to not pick up anything over 10#. My son was born at 9# 13 1/2 oz. So,... 🙄 Yeah, right. Anyway, my 1st x-ray said that I had an "L6"/ that was pseudo articulated... over the 26 yrs, I have seen a total of 17 drs (due to either insurance changes, moving or getting another opinion). NONE of them EVER brought up Bertolotti's Syndrome as a possibility. EVER. No one even mentioned it to discuss ruling it out. These docs collectively consist of GPs, neurosurgeons, orthopedic surgeons specializing in the spine & 5 (count them 1, 2, 3, 4, 5) pain specialists. Again, not a one of them EVER brought up Bertolotti's Syndrome. WTH?? I found it on a fluke. My back is killing me exactly where it hurts. Could it be Bertolotti's Syndrome?? 🤷🏼‍♀️ UGH! THANK YOU.

[@leec3073]

Mine is fused at the hip and sacrum which has now caused l4 l5 degenerative and slipped disc. I'm still now allowed surgery after 6 years of pain.

[@user-vj4wx5wb1y]

Thats great, but how’s the patient doing now? Has her pain issues been resolved? Im trying to get a diagnosis with my doctor/physio having already payed privately for xray which shows same L5 transverse. Total banging my head against a wall with the British NHS system!

[@SwedishTourist]

Is it possible to not have the lower back pain, but having it cause asymmetries further up in the back anyway?

[@teniatorres879]

I think I may have this idk I am 36 with degenerative l3-l5 I am currently waiting for a 3rd opinion after epidural shots and pt the dr wants to Fuze the discs.The new chiropractor that I just started seeing said after looking at the xrey I have a twisted sacrum but I just don't know. This video felt like you made it for me.

[@bondgirl66007]

I have this on my left side a LSTV with large spatulated TP, my spine has now degenerated badly on the suprajacent side with pars fracture at L4 and 5 and foraminal stenosis of L4\5 caused by disc herniation. I also have facet joint arthritis. My surgeon wants to do a TLIF with disc cages.. I’m too scared to go through that in case it fails. At the moment I can still walk for 30 mins, albeit with pain. I’ve tried every drug you can have including fentanyl.. the only thing that helps me with the chronic pain is nortriptyline, off label use. I’m nearing 60 now so I’m just hanging on as long as I can.

[@Reneebenson]

I recently found out I have this, I have a hue tolerance for pain but not this kind of pain I been Doing pt and 3 ibprofuen 3 times a day

[@stubblebarbers2464]

Thanks for the video. I am 39 and I have spinal cord stimulator and a lot of pain. I am also facing lumbar tear surgery. Do you think it is all related?

[@stubblebarbers2464]

I have a rudimentary vertabrae

[@laurenopferman7278]

Would this make it feel like the hip is locked in a way?

[@Thecatnamedkiwi]

Yes. I have this and I get this all the time. Feels like my hips get stuck

[@devilinsideanangel]

Me now wondering if this is my issue as opposed to sciatica cuz I've experienced sciatica and it's just in that area my left side though ..fibromyalgia my mom has n I'm told its directly hereditary not generational so we hope none of our 3 kids get it as my husband his dad and brother all have it too 🤦‍♀️

[@sejalshah3954]

Wow. That’s unbelievable that all 3 family members have this. How much pain are they all in? Please reply when you get a chance. Thanks so much!!🙏💜

[@senseofwonder4734]

❤

[@knib864]

On your short, you pointed to your left side :)

[@SuperGattan]

I am 53 and I have it from birth, I get mild pain only when i wash and wax my car. I believe the joint was separated when I was 16 year old doing stretching; when I heard a crack from lower area. only one doctor knew the cause of the pain; others said ridiculous things.

[@kpetchembouathibaut9188]

Hello

[@kpetchembouathibaut9188]

Hello how are you? I suffer from the same ailment. How have you managed to live with this evil since your 16 years old until now that you are 53 years old?

[@SuperGattan]

@@kpetchembouathibaut9188 surprisingly I get pain only when I do certain activity, for example waxing my car.

[@kpetchembouathibaut9188]

@@SuperGattan Did you do an x-ray that diagnosed that you have bertolotti syndrome?

[@kpetchembouathibaut9188]

What treatments did you use when you noticed that you were suffering from this disease?

[@steveOCalley]

Old joke - presenting a case - 52 y/o man with LBP worse with activity… “Bertolotti’s syndrome!” Said the medical student. “That’s right! Amazing! How did you know?” “Well, what else causes lower back pain?” Replies the confident student.

[@beerman1957]

10:1 it’s because she’s a female.

[@MzClementine]

Oh bless her. Interesting. Wow interesting.. I have I have HEDS and VEDS. I've avoided many surgeries... My lower back is bad. I love your less invasive moves... Heck yeah take that out.. woohoo yay. Get it on out.. What an eye.. I was staring at the screws. 😶‍🌫️🫣🥴