CASE 7

Courtesy of Almoosa Specialist Hospital

Low back pain

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CASE 7 ANSWER

Bertolotti Syndrome

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The most inferior and caudal lumbar vertebra demonstrates an enlarged left transverse process that shows pseudo-articulation with the left sacral ala (yellow arrow on the frontal radiograph and the yellow circles on coronal and 3D CT reformations)

Key Points

• Bertolotti syndrome demonstrates anatomic variation within the most inferior caudal lumbar vertebral body with a large transverse process that forms a pseudoarthrosis or a bony fusion with the sacral ala or the iliac crest.

• May lead to degenerative changes at the site of pseudoarthrosis, which could result in long-standing lower back pain.

• Usually presents in patients less than 30 years old.

• Can be treated by percutaneous injection of anesthetic and steroids or even radiofrequency ablation of the anomalous joint. Surgical option by osteotomy and fusion of the pseudoarthrosis is occasionally considered.