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Bertolotti Syndrome in the Pediatric Population: A Literature Review and Management Algorithm

Daniel C Gabriel1, David S Liu, Bryan Ang

  • 1From the Harvard Medical School, Boston, MA (Gabriel, Hines, and Prabhat); the Lenox Hill Hospital, New York, NY (Dr. Ang); and the Boston Children's Hospital, Department of Orthopedic Surgery, Boston, MA (Dr. Liu and Dr. Hogue).

Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews
|September 9, 2025
PubMed

Insights

This study proposes a step-wise management algorithm for pediatric Bertolotti syndrome, guiding treatment from conservative options to surgery. All reviewed pediatric patients experienced symptom resolution, highlighting effective management strategies for this condition.

Area of Science:

  • Pediatric Orthopedics
  • Spine Surgery
  • Medical Algorithms

Background:

  • Bertolotti syndrome is a congenital anomaly with a spectrum of clinical presentations.
  • Management strategies for pediatric Bertolotti syndrome require a structured approach.

Purpose of the Study:

  • To develop a comprehensive, step-wise management algorithm for pediatric Bertolotti syndrome.
  • To systematically review diagnostic evaluation, treatment options, and outcomes for this condition in children.

Main Methods:

  • Systematic literature review using PubMed.
  • Inclusion of studies focusing on pediatric Bertolotti syndrome management.
  • Data extraction on clinical presentation, imaging, treatment, and outcomes.

Main Results:

  • 17 pediatric patients from 13 studies were analyzed.
  • Lower back and radicular pain were primary symptoms.
  • Treatments included conservative measures (physical therapy, NSAIDs, bracing, injections) and surgical options (resection, fusion).
  • All patients achieved symptom resolution.

Conclusions:

  • A stepwise management algorithm for pediatric Bertolotti syndrome is proposed.
  • Recommend a progression from conservative to surgical treatment based on symptom persistence.
  • The algorithm aims to optimize outcomes for pediatric patients.
Abstract

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