A Rare Case of Bertolotti's Syndrome in a Young Patient: A Case Report and Literature Review

Abstract

Bertolotti's syndrome is a congenital condition characterized by the sacralization of the lower lumbar vertebrae or the lumbarization of the sacral vertebrae. The cause of pain in Bertolotti's syndrome is multifactorial. This lumbosacral transitional vertebra has a prevalence of 4% to 30%. Rarely, it is considered in the differential diagnosis of low back pain in young people. Therefore, every aspect of Bertolotti's syndrome needs to be meticulously addressed, and it should be included in the differential diagnosis of chronic back pain. Herein, we present a case of Bertolotti's syndrome presented with chronic lower back pain, confirmed on X-ray and magnetic resonance imaging (MRI). He was managed with analgesics and steroids injection with regular follow-up.

Radiological Diagnosis of Chronic Back Pain

“…Regarding the other three (incorrect) answer choices, Bertolotti’s syndrome is a condition associated with transition vertebrae either as sacralization of the fifth lumbar vertebra or vice versa. 8 Scheuermann kyphosis or Scheuermann disease is a juvenile kyphosis involving the thoracic vertebrae and rarely the lumbar vertebrae in adults with hyperkyphosis, successive three vertebral wedging up to five degrees and discogenic changes. 9 Apophyseal ring fractures are rare injuries that mimic common disc herniation (though sometimes they may accompany it).…”

Transitional lumbosacral vertebrae

“…Медикаментозными средствами так называемой «первой линии» считают противовоспалительные препараты и анальгетики [75]. Усиливают терапевтический эффект медикаментозные блокады в проекцию «ложного сустава», в область между поперечным отростком переходного позвонка и крестцовым крылом (или крыльями в случае двустороннего поражения, при типах Ib, IIb, IIIb, IV) [76]. Так, по результатам исследований J. Glemarec и соавт., блокады анальгетиком (лидокаином) в сочетании с глюкокортикоидом (кортивазолом) позволили получить стойкое купирование болевого синдрома в течение 12 нед у больных с переходными пояснично-крестцовыми позвонками.…”

Sacralization of Coccygeal Vertebra: A Descriptive Observational Study in Bangladesh

“…The five-pair sacral opening builds as a result of coccygeal sacralization, and the fifth pair of sacral and coccygeal nerves travel through this opening [ 15 ]. Sacralization infrequently causes symptoms and may remain unnoticeable throughout life [ 16 , 17 ]. Often, sacralization is diagnosed through a roentgenogram (X-Ray) examination for other pathological issues [ 17 ].…”

“…Sacralization infrequently causes symptoms and may remain unnoticeable throughout life [16,17]. Often, sacralization is diagnosed through a roentgenogram (X-Ray) examination for other pathological issues [17]. The detailed knowledge of sacral anatomical divergences impacts different medical arenas (orthopedic surgeons, neurosurgeons, neurologists, urologists, anesthesiologists, obstetricians, radiologists, forensic doctors, and all surgical specialists operating close to the vertebral column) [18][19][20].…”