Bertolotti Syndrome in the Pediatric Population: A Literature Review and Management Algorithm.

Purpose: The purpose of this study was to develop a comprehensive step-wise management algorithm for Bertolotti syndrome in the pediatric population by conducting a systematic review of the current literature regarding the diagnostic evaluation, nonsurgical and surgical treatment, and outcomes.

Methods: A systematic review of the literature was conducted using PubMed to identify studies focused on the management of Bertolotti syndrome in the pediatric population. Data extraction of clinical presentation, management strategies, imaging, and outcomes was completed.

Results: Thirteen studies reported on 17 patients younger than 18 years with confirmed diagnosis of Bertolotti syndrome were identified. Lower back pain was the most common presenting symptom and was described in all 13 studies. Radicular pain was described in six of 13 studies. Diagnostic, intraoperative, and postoperative assessments included preoperative radiographs, CT, MRI, along with targeted injections. Treatment options ranged from nonsurgical to surgical measures. Conservative options included physical therapy, nonsteroidal anti-inflammatory medications, bracing treatment, and targeted injections. Surgical modalities included open surgical resection and posterior spinal fusion. All patients in the 13 studies demonstrated partial or complete resolution of their presenting symptoms.

Conclusions: This study provides a proposed systemic algorithm for the management of Bertolotti syndrome in the pediatric population. Based on our review of the current literature, we recommend a stepwise approach to the management of Bertolotti syndrome starting from conservative options and progressing toward surgical treatment if symptoms persist.