Bertolotti Syndrome: A Frequently Brushed Aside Reason for Low Back Pain and Its Surgical Management

Bertolotti syndrome (BS), caused by a lumbosacral transitional vertebra (LSTV), is an often overlooked source of persistent low back pain (LBP) due to its overlap with other lumbar disorders and imaging limitations. We report a 23-year-old female with a 3-year history of left-sided LBP and imaging showing Castellvi type 2b LSTV. Conservative management failed, but a diagnostic steroid injection gave temporary relief, confirming the diagnosis. Surgical excision of the pseudoarticulation led to complete recovery, and the patient remained symptom-free at 1 year. This case report highlights the importance of early detection and imaging in BS, as well as the success of surgical resection in refractory patients.