739: Bertolotti s Syndrome - Prevalence in low back pain patients in an urban tertiary care centre

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Assessment and Measurement of Pain/Nociception, Epidemiology, Pain in Special Populations

Background and Aims: Bertolotti syndrome (BS) or lumbosacral transitional vertebra (LSTV) syndrome first
identified by Bertolotti in 1917, is a common cause of lower back pain[1] The symptomatology extends from asymptomatic incidental finding to a constant source of a low backache in adolescent to middle-aged population. Presence of LSTV results in changes in biomechanics of load transmission resulting in significant morphological changes in various parts of spine, such as changes in width of lamina and cancellous bone content, reduced height of pars interarticularis, alteration in facet morphology, disc degeneration leading to LBP [2].The presence of an LSTV can result in pinching of a lumbar spinal nerve between the transverse process of the 5th lumbar vertebra and the sacral ala, a condition known as "Far-Out Syndrome" [6].
Aim of the study :1. To estimate the prevalence of BS in patients with LBP
2. To produce frequency estimates of BS, overall and for population subgroups.

Methods: After approval from Institutional Ethics Committee , total 740 patients both male and female, aged 18 years and above, clinically presenting with lumbago, pygalgia or lower back or buttock pain, isolated or associated with radiculopathy with pain persisting for more than 3 months with NRS more than 5 and coming to the Out Patient Department of pain clinic of ESI Institute of Pain Management, Kolkata were recruited in the study.
Patients were investigated through a Ferguson view AP radiograph which served as the reference standard method for the presence of a LSTV (7,8) or a mega- apophysis/transverse process of L5 pseudoarticulating with iliac crest or forming a sacroiliac neo joint.
If pain is present at pseudoarticulation site on palpation then a diagnostic injection of 3 ml local anesthesia ( 2% lignocaine) is given at pseudoarticulation site btw transverse process of l5 and iliac crest or sacro-iliac neo joint site(pseudo-articulation site)

Results: In this prevalence study of 740 patients presenting with low back pain, 505 were males and 235 were females.
Among males, 167 individuals (33.1%) were found to have lumbosacral transitional vertebrae (LSTV), while 86 (17.0%) had Bertolotti syndrome. In the female cohort, LSTV was identified in 49 patients (20.9%), and 27 (11.5%) were diagnosed with Bertolotti syndrome. Overall, the prevalence of LSTV in the study population was 29.2% (216/740), and Bertolotti syndrome was observed in 15.3% (113/740) of patients.
Both LSTV and Bertolotti syndrome were more commonly seen in males compared to females. Additionally, a substantial proportion of patients with LSTV were symptomatic, as reflected by the coexistence of Bertolotti syndrome. These findings highlight a notable prevalence of transitional vertebrae and associated symptomatology in patients with low back pain, with a clear male predominance in this cohort.

Conclusions: Bertolotti's Syndrome with LBP presents a diagnostic challenge to a clinician ,due to multifactorial origin of pain . Identifying the exact pain source requires a combination of imaging modalities such as X-ray, MRI,CT scan, SPECT and bone scan.
The study population mainly included mill and factory workers engaged in heavy lifting and repetitive bending ,which may contribute to higher prevalence of this condition.
The findings suggest that Bertolotti 's is often underdiagnosed and should be considered in patients with LBP.Diagnostic injections at pseudoarticulation site can help confirm diagnosis .
Individualised treatment is essential and further large scale studies are needed to establish clearer diagnostic and management guidelines.

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2. Mahato NK. Facet dimensions, orientation, and symmetry at L5-S1 junction in lumbosacral transitional States. Spine (Phila Pa 1976). 2011;36(9):E569-73.
3. . Bertolotti M. Contributo alla conoscenza dei vizi di differenziazione regionale del rachide con special riguardo all assimilazione sacrale della v. lombare. Radiologiqu Medica. 1917(4):113-44.
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Presenting Author: Dr Shanal Alima
Submitting Author: Shanal Alima

Senior Author: Dr Arihant Jain

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Dr.Arihant Jain: MBBS,MD(Anaesthesia , critical care and pain medicine ),FCCS,FPM,CCEPC - MAA KAMKHAYA Multispeciality Hospital Bijnor,UP