[Bertolotti syndrome: an often overlooked cause of specific back pain]

Lumbosacral transitional vertebrae (LSTV) are common, with a prevalence of 15-35%, and can be a cause of specific low back pain. The insufficient awareness of this anomaly often leads to delayed diagnosis and treatment.

This study explains the anatomical and biomechanical basis of Bertolotti syndrome and discusses diagnostic and therapeutic options.

This systematic review was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The SCOPE criteria (Structuring Comparative Outcome Reporting in Epidemiology) were considered to ensure comprehensive and transparent reporting. A systematic search was performed in PubMed using the search terms 'Bertolotti', 'Bertolotti syndrome', and 'Lumbosacral transitional vertebrae' by a single investigator, resulting in the inclusion of 112 studies. Articles that were not available in English or German were excluded.

Patients with symptomatic Bertolotti syndrome often suffer from chronic low back pain and radiculopathies. Imaging techniques, particularly X‑rays and MRI, play a key role in diagnosis. Conservative treatments show limited success. Surgical resection of the transverse process (processectomy), especially after positive test infiltrations, leads to significant pain relief, particularly in younger patients without degenerative changes.

Treatment choice depends on individual anatomy and the presence of degenerative changes. While conservative measures are initially recommended, processectomy shows promising results in carefully selected patients. Fusion surgeries should only be considered in cases of instability. Further studies are needed to confirm the effectiveness of invasive procedures.