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Bertolotti’s syndrome is named after the Italian scientist who discovered it. It is a congenital condition that is associated with back pain, particularly in individuals who are in their twenties and early thirties.

What Exactly Happens In This Syndrome?

This syndrome was actually described by Bertolotti in 1917. He said that the most caudal vertebra fuses with the sacrum or ilium. This results in disc disease at the level of L4-L5. The manner of fusion of the transverse processes of the vertebra might be unilateral or on both sides.

This fusion then results in a restricted range of motion, persistent back pain and degenerative changes in the discs.

Symptoms include:

  • Lower back pain
  • Numbness
  • Tingling sensation down the side of the leg
  • Discomfort during a wide range of movement

Why Does Bertolotti’s  Syndrome Occur?

The exact cause of the occurrence of Bertolotti’s syndrome is still unclear, however there are some theories that researchers believe might be close to the answer.

One of the most accepted theories among these is one which states that the vertebra above the transitional one seems to be most likely to suffer from degenerative changes while the disc below seems to be protected. This could be because the vertebra above is subjected to a higher torque and hypermobility, thus putting more strain on the anatomic structures.

Diagnosis

Patients suspected to be suffering from Bertolotti’s syndrome will be required to undergo MRI scans for confirmation. The initial diagnosis is made on the basis of a thorough medical history and clinical examination.

Treatment

One of the common lines of treatment that are followed includes the injection of steroids to control the inflammation and local anesthetic to help numb the pain near the site of the fusion. Almost all patients will report an immediate decrease in the level of their discomfort, however, there is a chance that the symptoms will return over a period of time.

The other common option is to surgical intervention. Here the surgeon may choose to resect one of the anomalous fusion sites and thus return the normal range of motion, or go for a fusion of the transitional segment.

There is a debate as to what the best way is to treat symptoms arising from Bertolotti’s syndrome and the treatment options offered to the patients may differ widely between different surgeons.

As a rule of thumb, it is always better to give non-surgical treatment a go before moving on to more invasive plans, particularly since no one method has been shown to conclusively better than the other.

Conclusion

There are numerous studies that have found Bertolotti’s syndrome to be much more widely prevalent than earlier thought. It should be something that is considered whenever a young patient presents with persistent pain and discomfort.

There is also another school of thought which actually disputes that this type of fusion should be regarded as a separate "syndrome", however, that is more of an academic question rather than having any bearing on patient treatment.

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