A Narrative Review of Bertolotti's Syndrome: Etiology, Classification, Diagnosis, and Treatment

Bertolotti's syndrome is a congenital condition characterized by chronic low back pain stemming from a lumbosacral transitional vertebra (LSTV). Because the condition is frequently overlooked, patients often face years of delayed diagnosis before the true source of their pain is identified. Furthermore, current information regarding the biological origins and clinical management of the condition remain scattered. To address this knowledge gap, this narrative review aims to provide a comprehensive overview of Bertolotti's syndrome by consolidating these disparate sources and suggesting new connections. We synthesize the latest understanding of this condition, ranging from its genetic origins to modern clinical management. We examine the biomechanical alterations caused by an LSTV and discuss the advantages of Jenkins classification over Castellvi classification. The diagnostic protocol is presented as a multi-step process, emphasizing the necessity of fluoroscopy-guided diagnostic injections to distinguish incidental findings from true pathology. Finally, we present the consensus treatment protocol based on the latest findings and identify critical gaps in the literature regarding standardized care protocols, unified clinical nomenclature, and long-term surgical outcomes.