Bertolotti Syndrome: Understanding a Hidden Cause of Lower Back Pain

Many people suffer from chronic lower back pain without knowing the underlying cause. While disc problems and muscular issues are often suspected, a lesser-known condition called Bertolotti Syndrome may be the culprit—particularly in young adults or those whose pain does not respond to standard treatments. In this article, we explore what Bertolotti Syndrome is, how it presents, and the available treatment options.

What is Bertolotti Syndrome?

Bertolotti Syndrome is a congenital condition in which the lowest lumbar vertebra (L5) abnormally connects to the sacrum or pelvis through a bony or fibrous joint. This abnormality—known as a lumbosacral transitional vertebra (LSTV)—can lead to altered biomechanics in the lower back, resulting in chronic pain, joint stress, or early disc degeneration.

Not all cases of LSTV cause symptoms. Bertolotti Syndrome is specifically diagnosed when this anatomical variation becomes painful or functionally limiting, especially in young, active individuals.

Key Symptoms and When to Suspect It

Many patients with Bertolotti Syndrome describe a deep, aching pain in the lower back, often worse after prolonged sitting or activity. Pain can also radiate to the hips or legs, mimicking sciatica. Key warning signs include:

• Persistent lower back pain starting in adolescence or early adulthood

• Pain not relieved by physiotherapy or standard treatments

• Localised tenderness near the lumbosacral junction

• One leg feeling shorter or a visible pelvic tilt

Diagnosing Bertolotti Syndrome

A correct diagnosis requires careful imaging, as the syndrome is often missed or misdiagnosed as simple mechanical back pain. At MSK Doctors, we use a combination of:

• X-rays to identify bone abnormalities

• MRI scans to assess disc and nerve involvement

• onMRI™ (Objective Numeric MRI) to quantify degeneration and inflammation

• Motion analysis (via MAI-Motion™) to assess the biomechanical impact of the transitional vertebra

A diagnostic injection around the pseudo-joint may be used to confirm if it is the true pain generator.

Treatment Options for Bertolotti Syndrome

At MSK Doctors, we adopt a tiered approach prioritising non-surgical and regenerative therapies, only escalating to surgery if necessary. Treatment may include:

1. Targeted Injections

Diagnostic and therapeutic steroid injections into the pseudo-joint can reduce inflammation and help confirm diagnosis.

2. Regenerative Injections

In cases where inflammation is recurrent, Platelet-Rich Plasma (PRP) or Bone Marrow Aspirate Concentrate (BMAC) can be used to support tissue healing and reduce dependency on steroids.

3. Biomechanical Correction

Physiotherapy based on motion analysis can address compensatory postures and muscle imbalances caused by pelvic tilt or altered leg length.

4. Minimally Invasive Surgery

In severe cases, minimally invasive excision of the pseudo-joint or fusion surgery may be offered to eliminate the source of pain. These are considered when conservative options fail after a comprehensive trial.

FAQs about Bertolotti Syndrome

1. Is Bertolotti Syndrome a form of arthritis?

No, but it can lead to early joint wear and degeneration. The abnormal joint created between the lumbar spine and pelvis may become inflamed, mimicking arthritic pain.

2. How is it different from regular back pain?

Bertolotti Syndrome causes pain from a structural abnormality, not just muscle strain. Unlike typical mechanical back pain, it often starts in young adults and is persistent despite exercise or rest.

3. Can Bertolotti Syndrome be seen on MRI?

Yes—but plain MRI might not identify the transitional vertebra clearly. At MSK Doctors, we combine X-ray, MRI, and onMRI™ technology for accurate assessment.

4. Is surgery always needed?

No. Most patients respond well to non-invasive treatments, including injections and motion therapy. Surgery is a last resort for those with persistent symptoms.

5. What is the recovery time for Bertolotti Syndrome treatment?

Recovery depends on the treatment approach. Injections may relieve pain within days, while regenerative therapy may take several weeks to show full effects. Surgical recovery can take several months but is rarely required.

6. Can Bertolotti Syndrome affect sports performance?

Yes. Athletes may experience reduced flexibility, strength imbalance, or recurring injury. Proper diagnosis and treatment can restore function and allow a return to peak performance.

When to See a Specialist

If you’ve had chronic lower back pain without relief from typical therapies—or if you’re a young adult with pain not explained by disc or muscle issues—Bertolotti Syndrome should be considered. At MSK Doctors, we specialise in diagnosing complex causes of musculoskeletal pain and offer both advanced imaging and regenerative options.

No GP referral is needed. We can provide immediate access to scanning, motion testing, and treatment planning—all under one roof.