Complete, Sustained Resolution of Pain With Pseudoarthrectomy for Bertolotti Syndrome: A Case Report

Bertolotti syndrome, characterized by lumbar pain due to a lumbosacral (LS) transitional vertebra, is a known but still controversial and overlooked pain generator despite an explosion of information on the condition in the last decade. Current management includes plain radiography, advanced imaging, minimally invasive interventions, and LS fusion.

We present a unique case of a middle-aged man with Castellvi IIa Bertolotti syndrome consisting of a unilateral enlarged, dysplastic L5 transverse process forming a pseudoarticulation (PA) with the ilium and normal anatomy contralaterally. He was diagnosed on a plain radiograph and following a diagnostic injection of the PA, he received complete, sustained pain relief from a pseudoarthrectomy.

This case illustrates an economical and thoughtful approach to diagnosis and management that may offer pain relief rather than invasive management with surgical fusion that comes with its own morbidity and mortality and consequences, such as adjacent-level disease.