Bertolotti’s syndrome: an underdiagnosed cause for lower bac
The present case has been reported in the Journal of Surgery Case Reports. Bertolotti’s syndrome refers to the presence of pain associated to the anatomical variant of sacralization of the last lumbar vertebra. It is often a factor that is not addressed in the evaluation and treatment of lower back pain.

A 42-year-old female presented with a history of chronic low back pain. She reported no relevant medical history. She had already been treated in the last 4 years by general practitioners with analgesics and home-based physiotherapy with no satisfactory results. She had two previous admissions to the emergency department where morphine was prescribed to control the pain on her lower back. She was under ambulatory treatment with diclofenac, and tizanidine with partial relief of symptoms.

Her main complaint was pain on the lower lumbar back with no radiation to the lower extremities. In her physical evaluation she presented limitation to full rotation and bending of the lumbar spine due to pain. Lasegue sign was negative, sensitivity, reflexes, sagittal balance, distal muscular strength and pulses were normal.

Radiographs revealed an overdeveloped left transverse process of the fifth lumbar vertebra which contacts with the sacrum at the left sacral wing with signs of degeneration at the same site. MRI studies were obtained. The patient was taken to the operating room where infiltration with 1 mL of lidocaine and 40 mg of Triamcinolone was performed in the pseudoarticulation between the left transverse process and the sacrum under fluoroscopic guidance.

She reported a complete relief of pain after the procedure. At three months follow-up she was managed with strengthening and stabilizing exercises for the lumbar spine and postural education was initiated. She remains asymptomatic at her 12 months follow up.

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