Unilateral biportal endoscopic pseudoarthrectomy for Bertolotti syndrome: A technical note with three illustrative...

Bertolotti syndrome, characterized by chronic lumbosacral pain associated with lumbosacral transitional vertebrae (LSTV), can be refractory to conservative care. Unilateral biportal endoscopy (UBE) offers a minimally invasive approach with enhanced visualization and instrument maneuverability, yet its specific application for pseudoarthrectomy in this syndrome remains underreported.

We describe the UBE technique and illustrate its application in three adults with Bertolotti syndrome treated at a single center between 2024 and 2025. Symptoms persisted in all three patients despite at least 6 months of conservative treatment. All patients underwent UBE-assisted resection of the symptomatic lumbosacral pseudoarticulation, with concomitant neural decompression performed as indicated. Perioperative data were recorded, and clinical outcomes were assessed using the visual analog scale (VAS) and the Japanese Orthopaedic Association (JOA) score.

All procedures were successfully completed without conversion to open surgery or major complications. Operative times were 180, 150, and 101 minutes, respectively. All patients ambulated on postoperative day 1. For Patients 1, 2, and 3, respectively, VAS scores decreased from 5/5/6 preoperatively to 2/3/3 at discharge and 0/1/1 at the 6-month follow-up. Corresponding JOA scores increased from 22/21/18 preoperatively to 25/24/21 at discharge and 28/27/26 at the 6-month follow-up.

UBE-assisted pseudoarthrectomy may represent a feasible minimally invasive approach for selected patients with symptomatic Bertolotti syndrome. It provides superior magnified visualization for targeted resection while preserving posterior stabilizing structures. Although initial case illustrations show encouraging early symptom relief, large prospective studies with extended follow-up are required to validate its long-term clinical efficacy.