Bertolotti's syndrome

 Introduction: 

Bertolotti's syndrome is a type of lower back pain(waist line region) in which the transverse process of L5 vertebra fused with the sacrum or ilium causing discogenic disease and limited mobility around lumbo-sacral region. The pain caused by Bertolotti's syndrome is not uniform and originates from different pathology caused by the lumbosacral transitional vertebra(LSTV).It was first described in  1917 by Italian physician named Mario Bertolotti's.

Cause of Bertolotti's syndrome:

As the development of our body takes place, there is also spinal growth in which vertebrae located in the sacral region fuse together to form one bone called the sacrum of pelvis. similarly lumbar vertebra also grows with segments of transverse process and spinous process which provide movement at the lumbar region.

In some instances, during the developmental stage this transverse process typically enlarged and often looks like a fake joint which touches the pelvis. This fake joint between the enlarged transverse process and the sacrum, if inflamed causes back pain and looks similar to sacroiliitis, lumbar disc pain, and facet joint pain.

Bertolotti's syndrome

This is the X-ray of 67 year old women showing  Bertolotti's syndrome ( the red circle shows transverse mega -apophysis of L5 with pseudoaticulation with the sacral ala)

Classification of Bertolotti's syndrome:

On the basis of LSTV It is classified into four categories 

Type 1: At the lumbosacral junction a dysplastic transverse process shows a gap of less than 10mm,but greater than 2mm at lumbosacral junction.

Type 2: A gap less than 2mm at the pseudo articulation between adjacent transverse process.

Type 3: At the lumbosacral junction, complete fusion lateral to the facet at the ala, without spontaneous fusion of the disc of facet joints.

Type 4: Presence of unilaterally fused side with varying pseudo-articulation.

 
Diagnosis of Bertolotti's syndrome:

A physical therapist does the physical examination of patient including evaluation and assessment by checking the point of tenderness around the waist line, spine mobility, edema, and differentiate the other types of back pain with Bertolotti's syndrome. Lumbosacral spine radiographs helps in identification of the skeletal abnormality while MRI helps in confirmation.

Treatment of Bertolotti's syndrome:

Physical therapy should be first line of treatment as conservative and non-operative of this syndrome, other treatment include steroid injection, radiofrequency ablation and lastly surgical intervention. surgery carries higher risks and is reserved for patients failing previous lines of treatment.  

 Once the diagnosis is confirmed of Bertolotti's syndrome, therapist makes a treatment plan accordingly followed by a rehabilitation program. The overall physical therapy treatment includes:-

 1. Stretching exercises

2. Electrotherapy modalities

3. Manual techniques 

4. Strengthening exercises 

5. Range of motion exercises

6. Breathing exercises 

Stretching the back muscles is described in the video by professionally qualified Physical therapist Dr shailendra chourey

 

Benefits of Physical therapy

The benefits of physical therapy treatment is that it reduces the tightness of muscles around lumbosacral region by stretching the muscles such as lattisimus dorsi, gluteal muscles, erector spinae, thoracolumbar fascia, hamstring muscle, pyriformis and many more. 

Therapist also work on flexibility of LS spine to reduce the stiffness and increase range of motion. Muscle spasm and pain is reduced by electrotherapy modalities, and a good therapist will do the stretching of tight muscles and strengthening of weak muscles, thus physical therapy works overall on Bertolotti's syndrome treatment and management. 

What if untreated bertolotti syndrome ?

Most patient's can live their life without any discomfort or problem. Leaving symptomatic Bertolotti's syndrome untreated may cause worsening pain, affecting day to day activities, and premature degeneration of lumbar spine. Over a period of time, this may also lead to other problems in your spine such as spondylosis, disc herniation, chronic low back pain and radiculopathy. Talk to your physical therapist to see what you can do to overcome it and prevent it.

Related article- how do you know when you need physical therapy?

Conclusion:

 Being a physical therapist my aim is to treat patient according to the

 condition and educate him/her in a proper way so that  he/she

  should not be hesitated to deal with any kind of musculoskeletal

problem  in future. Myself  Dr Shailendra Chourey in practice of

 physical therapy since 2010 comes to a conclusion that you should

 not ignore any type of back pain whether it is acute or chronic and

 must visit a physical therapist for correct treatment.

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