Lower back pain in young people is often attributed to muscle strain or sports injuries. However, in some cases, a congenital anatomical abnormality may be the root cause of the problem and requires specific evaluation.
What is a lumbosacral transitional vertebra and why can it hurt? (Bertolotti)
A lumbosacral transitional vertebra is a Congenital variation in which the last lumbar vertebra has a shape intermediate between a lumbar and sacral vertebra. When this anatomical alteration is associated with lower back pain, it is called Bertolotti syndrome.
Pain can occur because this transition alters how loads are distributed in the lower back. Among the most common causes They are found:
- anomalous contact between the vertebra and the sacrum or pelvis, which can cause local inflammation.
- Disk overload located above, by changing the normal mechanics of the movement.
- Premature wear and tear of the nearby joints.
- Irritation of nearby nerve structures.
- Muscle imbalances derivatives of asymmetry in the lumbosacral area.
Symptoms of Bertolotti syndrome: unilateral lower back pain and locking with certain movements
The most frequent symptom is lower back pain, It is usually on one side only. It is typically located near the junction between the lumbar spine and the pelvis.
It is characteristic for the pain to increase with certain movements, such as extending the back backward, twisting the torso, or performing repetitive exertion. Some people report feeling of being blocked or stiff when getting up, after sitting or after physical activity.
Buttock/groin pain or “false sciatica”: typical patterns in young athletes
In addition to lower back pain, It can radiate to the buttocks or the groin region. It is sometimes interpreted as sciatica, although there is not always actual nerve compression.
In young athletes, pain often appears during intense workouts, changes of direction, or impact exercises. This unilateral and mechanical pattern points to a structural origin in the lumbosacral region.
How Bertolotti is diagnosed: X-ray, CT/MRI, and what to look for in the report
The diagnosis of Bertolotti syndrome begins with clinical suspicion in the presence of Unilateral and persistent lower back pain in young patients. Confirmation is done through imaging tests.
The lumbosacral x-ray is the initial study and usually allows Identify the transitional vertebra and its relationship to the sacrum or pelvis. CT scans offer greater accuracy in bone assessment, while MRI helps to analyze discs, joints, and rule out hernias or other associated causes.
In it radiological report It is advisable to provide details:
- Presence of a lumbosacral transitional vertebra.
- Type of union with the sacrum or ilium.
- Changes to the upper disk.
- Signs of inflammation or overload in neighboring structures.
Castellvi classification: what it is for and how it guides treatment
Castellvi's classification It organizes the transitional vertebrae according to their morphology and the degree of union with the sacrum, whether it be widening, pseudoarticulation or complete fusion, unilateral or bilateral.
This classification allows cto better understand the origin of the pain and guide the treatment. Pseudo-joints are often associated with localized pain, while fusions can cause overload at the upper level. Identifying the type facilitates deciding between conservative management, interventional techniques, or surgery.
Why Bertolotti is confused with hernia or contracture: practical differential diagnosis
Bertolotti syndrome It shares symptoms with other common causes of lower back pain.. Unilateral pain and radiation to the buttock or thigh may suggest a herniated disc.
Also It can be interpreted as a muscle contracture when the pain is localized and increases with activity. However, in many cases, the MRI does not show clear nerve compression, and the pain persists despite treatments directed only at the muscle.
When the clinical presentation is mechanical, repetitive, and does not improve with conventional approaches, it is important Review imaging tests to rule out a transitional vertebra as the origin of the pain.
Conservative treatment of Bertolotti syndrome: exercise, physiotherapy and load management
Initial treatment is usually conservative. The goal is to...reduce the overload on the lumbosacral junction and improve the stability of the area.
The most used measures include:
- Therapeutic exercise focused on lumbar stabilization and movement control.
- Physiotherapy to reduce muscle tension and optimize mobility.
- Temporary modification of sports or work activity.
- Postural education and progressive load control.
Which exercises usually help and which ones make things worse, depending on the pain pattern?
The type of exercise should be adapted to each patient's pain pattern and tolerance. In general, the following are prioritized: movements that improve lumbar control without generating excessive compression in the lumbosacral region.
They usually be useful:
- Core stabilization exercises with pelvic control.
- Glute and deep abdominal muscle work.
- Gentle hip mobility to reduce lumbar overload.
- Low-impact activities such as walking or swimming, if they do not cause pain.
Instead, symptoms can worsen:
- Repeated hyperextensions of the spine.
- Sudden rotational movements under load.
- High-impact exercises or intense changes of direction.
- Weightlifting without proper technical control.
Injections and radiofrequency at Bertolotti: when they are used and what relief to look for
When conservative treatment fails to control pain, interventional techniques may be considered. The infiltrations are performed in the area of abnormal contact. between the vertebra and the sacrum or pelvis, with the aim of reducing inflammation and confirming the origin of the pain.
In addition to its therapeutic effect, The infiltration has diagnostic valueIf the pain clearly improves after the procedure, it reinforces the suspicion that the pseudo-joint is the source of the problem.
Radiofrequency ablation may be considered in selected cases. Its purpose is reduce pain transmission by acting on the responsible nerve structures, seeking relief that lasts over time.
Surgery in Bertolotti syndrome: pseudoarticulation resection vs fusion, when to consider
Surgery is reserved for patients with persistent pain, functional limitation and clear confirmation of the origin Mechanical in the transitional vertebra. It is not the first option and is indicated after exhausting conservative and interventional measures.
There are two main approaches. Pseudoarticulation resection consists of eliminate abnormal contact that generates friction and inflammation. Lumbosacral fusion occurs when instability or degeneration exists significant at the affected level.
When to seek specialist evaluation for lower back pain in young people with suspected Bertolotti syndrome
A professional evaluation is recommended. When lower back pain in a young person is persistent, unilateral, and does not improve with usual measures. Also when there are findings of a transitional vertebra in imaging studies accompanied by compatible symptoms.
A specific assessment allows confirm the diagnosis, rule out other causes, and establish an individualized treatment plan depending on the clinical and anatomical aspects of each case.
In cases of persistent lower back pain in young people with suspected Bertolotti syndrome, it is possible ask a date with our team specializing in the Institute of Advanced Spine Surgery (ICAC).
