Bertolotti’s syndrome: Lumbosacral transitional vertebrae (LSTV)

Background: Bertolotti’s syndrome is unexceptional anatomical variant occurring at the lumbosacral junction between the 5th lumbar vertebrae (L5) and the 1st sacral vertebrae (S1). Bertolotti’s syndrome as apart from lumbosacral transitional vertebrae (LSTV) are frequently encountered source of low back pain facing the physicians during the rheumatology practice. Case Description: A 28-year-old single female seen in rheumatology clinic in December 2022 with lower back pain. The pain was continuous but increase by daily activities. Plain radiographic studies demonstrate elongated of L5 transverse process and sacralization of L5 vertebrae. Magnetic resonance imaging (MRI) was performed, which revealed a fusion of the transverse process of L5 to the sacrum with uncomplicated two-sided pseudoarticulations which confirmed a diagnosis of Bertolotti’s Syndrome. She was treated with short course of NAIDS and with ideal benefit. In June 2024, she suffered again from low back pain with same character, but she added left lower limb paresthesia. Magnetic imaging study of the lumbosacral spine now shows symmetrical central posterior disc at the level of L4 & L5 causing indentation of the ventral aspect of thecal sac and mild bilateral neural foraminal narrowing and nerve root compression. Conservative approach with analgesia and home physiotherapy was advised, Pregabalin in escalating dose was in progress.Conclusion: Bertolotti’s Syndrome not precisely linked to the patient complains making it a diagnostic and therapeutic challenges