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CASE REPORT
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 110-111

Low back pain in a young adult: A case of bertolotti syndrome


1 Director, Department of Pain Management, Painex Pain Management Clinic, Pune, Maharashtra, India
2 Consultant, Department of Pain Management, Painex Pain Management Clinic, Pune, Maharashtra, India

Correspondence Address:
Nivedita Page
Director, Department of Pain Management, Painex Pain Management Clinic, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.5005/jp-journals-10046-0120

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Aim: The aim of this report is to stress upon Bertolotti syndrome being a common cause of back pain in young adults and possible futility of interventional pain management in such cases. Background: Bertolotti's syndrome is characterized by unilateral or bilateral enlargement of the transverse process of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium. The syndrome affects 4 to 21% some reports stating incidence to be as high as 30% of the population. Diagnosis is not difficult if clinical suspicion is high, but mimics other common causes of low back pain. Treatment by interventional pain management may not be very effective as the problem is structural. Case report: A 32-year-old soldier with low back pain, not relieved with medication was diagnosed with right-sided sacroiliitis. X-ray showed fusion of the transverse process of the 5th lumbar vertebra with the iliac crest. A fluoroscopy-guided sacroiliac joint injection along with the injection of the pseudoarthrosis was performed with no relief. An MRI scan was done which revealed degenerative disc at L4-L5 level. Caudal epidural steroid injection was done, however, the patient failed to obtain relief. He was then referred to a spine surgeon who has advised him surgery. Conclusion: We conclude that Bertolotti's syndrome could be an important cause of intractable back pain in young adults. Being a structural anomaly, usually, surgical intervention is needed. Clinical implication: Patients with Bertolloti syndrome should be taken up for interventional pain management, after explaining guarded prognosis due to it being a structural anomaly.


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