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BERTOLOTTI SYNDROME.

Eduardo Achar1, João Paulo de Souza Sanches Trecco1, Robert Meves1

  • 1Irmandade Santa Casa de Misericordia de Sao Paulo (ISCMSP), Departamento de Ortopedia e Traumatologia, Pavilhao F. Simonsen, Sao Paulo, SP, Brazil.

Acta Ortopedica Brasileira
|September 25, 2025
PubMed
Summary
This summary is machine-generated.

Bertolotti Syndrome, caused by lumbosacral transitional vertebrae (LSTV), affects over 60% of low back pain patients in emergency settings. Recognizing LSTV is crucial for effective low back pain management.

Keywords:
Low Back PainLumbosacral RegionSpine

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Area of Science:

  • Orthopedics
  • Radiology
  • Anatomy

Background:

  • Low back pain is a widespread issue, with a significant portion of emergency visits attributed to it.
  • Lumbosacral transitional vertebrae (LSTV) are a common anatomical variation and a frequent cause of low back pain.
  • Bertolotti Syndrome is characterized by LSTV and associated low back pain.

Purpose of the Study:

  • To determine the prevalence of Bertolotti Syndrome in emergency department patients presenting with low back pain.
  • To evaluate the interobserver reliability of classifying LSTVs using established systems.

Main Methods:

  • Retrospective analysis of 469 lumbar spine radiographs from patients with low back pain.
  • Classification of LSTVs by two independent orthopedists using Tini and Castellvi systems.
  • Statistical analysis including Kappa agreement index for interobserver reliability.

Main Results:

  • Prevalence of Bertolotti Syndrome was high, approximately 61-62% across both observers.
  • Type I LSTV was the most prevalent (over 70%), followed by Type III (over 15%).
  • Bilateral transverse process involvement (IB morphology) was the most common presentation (over 50%).

Conclusions:

  • Bertolotti Syndrome has a high incidence in emergency patients with low back pain.
  • LSTV should be considered more often in the differential diagnosis of low back pain.
  • Improved recognition of LSTV can enhance management strategies for associated low back pain.