Bertolotti joint-related cyst: illustrative case

Area of Science:

• Spine Surgery
• Pain Management
• Radiology

Background:

• Bertolotti syndrome is an underrecognized cause of chronic low back pain, often linked to altered biomechanics or instability.
• Nerve root compression from the pseudoarticulation can lead to radiculopathy.

Purpose of the Study:

• To describe a unique case of Bertolotti syndrome presenting with a cystic lesion causing L5 nerve root compression.
• To highlight the diagnostic and management challenges posed by this rare presentation.

Main Methods:

• Case report detailing a patient with treatment-refractory low back pain.
• Review of imaging findings and surgical outcomes.

Main Results:

• A cystic lesion arising from the Bertolotti joint was identified as the cause of L5 nerve root compression.
• Surgical resection of the Bertolotti joint did not alleviate symptoms.
• Postoperative imaging revealed a hemorrhagic pseudocyst, suggesting persistent pseudoarticulation motion.

Conclusions:

• This case highlights a rare pseudocyst associated with Bertolotti syndrome, complicating management.
• Further characterization of Bertolotti syndrome and its imaging features is needed for optimized treatment strategies.