Bertolotti Syndrome

Understanding the Symptoms, Causes & Treatments of Bertolotti Syndrome

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Reviewed by: Dr. Christopher Good, Dr. Colin Haines, Dr. Ehsan Jazini, Dr. William Kemp

Unique Care for a Unique Condition.

Welcome to VSI (Virginia Spine Institute), where our spine doctors specialize in providing solutions and support for patients with Bertolotti Syndrome—a condition often misdiagnosed or undiagnosed and can lead to chronic lower back pain. Our world-renowned experts are dedicated to offering effective care, making VSI a unique destination for comprehensive Bertolotti Syndrome treatment. Many patients suffering from Bertolotti’s Syndrome have faced years of misdiagnosis or remained undiagnosed, experiencing persistent discomfort and uncertainty. At VSI, we pride ourselves on offering both non-surgical treatments not widely available elsewhere and advanced surgical treatments using modern technology to ensure faster recovery. Our experts work closely with you to develop a personalized care plan that best suits your needs.

As a premier spine center for Bertolotti Syndrome care, we make the process seamless for fly-in patients by managing every aspect of their journey, from medical coordination to travel support. We’re committed to helping you navigate the complexities of the condition and return to your daily life.

With virtual and in-person consultations available, VSI is dedicated to your path to recovery. Call (703)-337-3285 to get started.

What is Bertolotti Syndrome?

Bertolotti syndrome, also known as lumbosacral transitional vertebra (LSTV), is a congenital disorder that often manifests as chronic back pain along the waistline. It occurs when the transverse process of the fifth lumbar vertebra (L5) articulates with the sacrum, resulting in abnormal spinal mobility and associated discomfort. This condition is characterized by an irregular vertebral structure and can be a source of ongoing pain and discomfort for affected individuals. Often confused with sacroiliitis, this diagnosis affects less than 10% of the population and because of this it often goes undiagnosed. Bertolotti’s syndrome is a rare cause of back pain and can be treated by a qualified spinal specialist with modern spinal healthcare.

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Symptoms of Bertolotti Syndrome

Bertolotti Syndrome is associated with a transitional vertebra, which can cause a range of symptoms, though some individuals may remain asymptomatic. Lumbosacral transitional vertebrae symptoms often include lower back pain radiating from the sides of the waist, typically resulting from inflammation of the transitional vertebra. These symptoms can overlap with other spinal or musculoskeletal conditions, such as sacroiliac joint pain, lumbar disc issues, or lumbar facet joint pain, often leading to misdiagnosis of Bertolotti Syndrome.

Accurate diagnosis of Bertolotti Syndrome requires evaluation by an experienced spine specialist. Finding a spine surgeon who offers not only surgical solutions but also non-surgical treatment plans is beneficial for patients seeking a conservative approach. Identifying these symptoms is crucial for differentiating the condition and guiding effective spine treatment.

When to Seek Treatment for Bertolotti Syndrome

If you’re noticing symptoms associated with Bertolotti Syndrome and suspect a spinal issue, it’s crucial to consult a board-certified spine specialist. Early diagnosis and treatment are crucial for effective management and may expand your treatment options, which can diminish if symptoms persist. Due to its complex nature, Bertolotti’s Syndrome is often misdiagnosed.

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Common Causes of Bertolotti Syndrome

During our natural spinal development, vertebrae located in the sacral region fuse to form one bone called the sacrum. The sacrum is located in the region of the pelvis. In the lower back or lumbar spine, lumbar vertebral bodies develop as separate segments with their own discs, transverse processes, and spinous processes. Having these separate vertebral bodies allows for motion in our lumbar spine.

However, before birth, some individuals develop a condition where the lowest lumbar vertebra (L5) doesn’t fully determine whether it belongs to the lumbar spine or the sacrum. This results in a ‘transitional vertebra.’ In such cases, the L5 transverse process becomes enlarged, often forming a fake joint with the pelvis. If inflammation develops at the site of the fake joint between the enlarged transverse process and the sacrum, it can cause lower back pain and discomfort. This low back pain is often very similar to pain related to sacroiliac pain or even lumbar facet pain, which is why patients can be frustrated by misdiagnosis if not properly evaluated by a Bertolotti Syndrome expert.

Diagnosis for Bertolotti Syndrome

Selecting a spine doctor with experience in accurately distinguishing it from other causes of back pain—such as lumbar disc issues, facet joint pain, degenerative disc disease, and sacroiliac joint pain—is vital. During your initial consultation, a thorough health history and physical examination should be conducted, and specific diagnostic imaging may be required to pinpoint the exact source of pain. At VSI, we tailor Bertolotti Syndrome treatment plans to your unique needs, starting with a precise diagnosis to ensure the most effective and personalized approach to your spine care.

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Spine-specialized physical therapy to relieve back pain

Treatment Solutions for Bertolotti Syndrome

We prioritize personalized, non-surgical treatments as our initial approach. Our specialized spine physical therapy focuses on mobilization, core strengthening, and stretching to alleviate symptoms. Additionally, we provide outpatient regenerative medicine treatments, including stem cell therapy and platelet-rich plasma (PRP). These innovative therapies harness the body’s natural healing capabilities, offering safe, outpatient options with quicker recovery times than surgery.


However, for some patients, surgical intervention becomes necessary. Our minimally invasive spine surgery can effectively address L5 transverse process issues by reshaping the enlarged transverse process and removing the problematic transitional joint, providing significant relief. Alternatively, we offer minimally invasive spinal fusion for lumbosacral transitional vertebrae treatment to stabilize the affected area. Both surgical options are designed to minimize recovery time and maximize patient outcomes, ensuring tailored care for each individual’s unique needs.

Frequently Asked Questions about Bertolotti Syndrome

Steroid injections can help provide longer-lasting pain relief than medications. The pain people experience from Bertolotti’s Syndrome is due to the transverse process of the transitional vertebrae rubbing against the pelvis bone. Repetitive rubbing from daily activities can cause irritation and inflammation leading to pain. This is similar to arthritis in your joints. As your bones keep rubbing on each other, they become irritated, inflamed, and painful. The administered steroid injection calms down the inflammation and as a result, provides pain relief. 

Bertolotti’s Syndrome does not cause “sciatic” pain. However, Bertolli Syndrome can cause premature degeneration of the discs and vertebrae in your lumbar spine which may cause disc degeneration, disc herniation, or nerve irritation. 

Most patients with Bertolotti Syndrome can live their life without any problems. Leaving symptomatic Bertolotti Syndrome untreated may cause worsening pain, impact on daily activities, and premature degeneration of the lumbar spine. Over time, this also may lead to other complications in your spine such as disc herniations, spondylosis, and radiculopathy. The sooner you have this evaluated likely the more treatment options will be available to you.

X-rays of your lower back/pelvis are the most common imaging technique used to identify Bertolotti Syndrome. When looking at the X-rays, our spine team is looking for an enlarged transverse process on the transitional vertebrae (usually L5, the lowest lumbar vertebrae). Sometimes if the X-rays are not clear enough, we may order a CT scan of your lower back/pelvis to better assess the bony anatomy and to rule out any other pathologies that may be contributing to the pain such as sacroiliitis.

Uncertain After Reviewing Bertolotti Syndrome Symptoms?

Schedule a professional evaluation with VSI for expert diagnosis and personalized guidance. We recommend in-person consultations with our spine specialists for the most thorough assessment.

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