Anatomy Meets Inflammation: An Imaging Case of Bertolotti Syndrome and Sacroiliitis

This case presents a unique anatomical and inflammatory interplay interplay between Bertolotti’s syndrome and axial spondyloarthritis in a young adult with chronic back pain. MRI revealed a Type IIa lumbosacral transitional vertebra with pseudo articulation-related marrow oedema, alongside sacroiliitis with active inflammatory features. This radiological “double act” underscores the complexity of distinguishing mechanical anomalies from inflammatory pathology in the spine. By fusing clinical insight with high-resolution imaging, this case illustrates how modern diagnostics can decode overlapping pain generators—ensuring that treatment targets both structure and inflammation in a personalized, precision-driven approach to back pain.