528 - Bertolotti's Syndrome: An Uncommon Cause of Chronic Back Pain

Case Diagnosis: Bertolotti’s Syndrome

Case Description: Patient is a 31-year-old male with history of compression spine injury, who presented to our rehabilitation outpatient services with complaint of recurring back pain. Patient has a history of injury five years ago followed by extensive physical therapy (PT), in addition to a single, recent PT session five months prior to this presentation. Patient initially saw improvement with therapy, but the symptoms returned. Per PT initial evaluation, the patient had decreased spinal mobility and strength, negatively affecting his functional status. The patient planned to undergo one PT session per week, entailing manual resistance, stretching, joint mobilization, and body mechanics training; however, the patient displayed poor compliance to therapy recommendations. On follow up, he endorsed worsening back pain with prolonged standing and sitting, at times improved with movement. A subsequent lumbar spine X-ray demonstrated a partial pseudoarthrosis of the left L5-S1 segments with no fracture dislocations, concerning for possible Bertolotti’s syndrome.

Discussions: Patient stated that his work in janitorial services was becoming increasingly difficult with his back pain and began to use a back brace for added support. Patient also had an epidural injection to spine approximately four years prior to presentation and reported adequate relief. Patient was provided with ambulatory referral to PT, home exercise therapy, and instructed to continue with heat pads and Tylenol use for pain management, with plan for follow up in three months.

Conclusions: Bertolotti’s Syndrome is a congenital defect caused by transitional lumbosacral vertebra, manifesting as either the fusion, articulation, or pseudo articulation of the transverse process to the sacrum or ilium, significantly limiting mobility. It is still considered an uncommon cause of chronic back pain. More studies that evaluate and describe the proper management of such causes of back pain are warranted.