Bertolotti syndrome: an often overlooked cause of specific back pain

Bertolotti syndrome: an underestimated cause of chronic low back pain

Bertolotti syndrome is a common but underdiagnosed cause of chronic low back pain in young adults. This condition is defined by the presence of a lumbosacral transitional vertebra (usually L5) with hypertrophy of the transverse processes, which may articulate or partially fuse with the sacrum or ilium.

This type of anomaly, which affects between 3% and 21% of the population, significantly alters the biomechanics of the lumbosacral spine, predisposing it to early disc degeneration and facet overload in adjacent segments.

One of the most common clinical findings is the presence of mechanical low back pain, often accompanied by structural scoliosis and radicular symptoms due to compression of nerve roots caused by narrowing of the intervertebral foramen.

Physiotherapeutic approach

Conservative treatment through physiotherapy plays a key role in controlling symptoms, improving functionality, and preventing degenerative progression.

The three most commonly used therapeutic pillars are:

• ✅ Specific spinal mobilization: to restore mobility in hypomobile segments adjacent to the transitional vertebra and reduce compensatory stiffness.

• ✅ Neurodynamic manual therapy: aimed at relieving irritation of the affected nerve roots using neural gliding techniques.

• ✅ Targeted stretching of the iliopsoas and quadratus lumborum: essential for reducing biomechanical tension in the pelvis and correcting muscle imbalances.

A personalized and progressive approach, based on individual clinical assessment, is essential to achieve sustained improvement in the patient.