Bertolotti Syndrome: Does it really exist? systematic review

Abstract

Study Design

systematic review.

Objectives

Bertolotti syndrome is described as the association between low back pain and transitional abnormalities of the lumbosacral spine. This association is nonspecific and does not justify surgical procedures on this anomaly, even percutaneous or minimally invasive. We consider that congenital variations of the lumbosacral junction are elements that modify the normal biomechanics of the spine and favor the development of other painful pathologies already known. This work is a systematic review that aims to determine whether Bertolotti Syndrome should be considered as an independent etiology of low back pain or only as a risk factor (Lumbosacral transitional vertebrae) for developing biomechanical alterations that produce pain.

Methods

The search used the following terms (PubMed, Embase, Cochrane library and clinical trials): Bertolotti syndrome, low back pain, lumbosacral transitional vertebrae. The search covered the last 21 years (2013 to 2024). The “Rayyan” program was used to gather information and facilitate the analysis process. Each author reviewed the abstract of the articles found. Inclusion: Systematic reviews, clinical trials, observational studies, and case series. Exclusion: Theoretical articles, narrative reviews, and articles in languages other than English.

Results

Initial analysis: 285 articles were selected (PubMed-115, Scopus-76, Embase-94), 238 articles were excluded (due to duplicated articles or titles not meeting inclusion/exclusion criteria). 47 articles were selected (25 retrospective clinical studies, 12 case series, 3 randomized clinical trial, and 7 systematic reviews; meta-analyses were not found). The PRISMA checklist was applied, and each article were assessed using the STROBE and CONSORT checklists.

Conclusions

Low back pain in patients with congenital abnormalities of the lumbosacral junction requires extensive clinical and radiological evaluation to determine the cause of the source of symptoms. Transitional anomaly is only a risk factor that modifies the normal biomechanics of the lumbosacral spine and not the therapeutic target. Bertolotti syndrome is an anecdotal but not objective association of the origin of pain.