Diagnostic Injections and Surgical Outcomes for treatment of Bertolotti’s Syndrome

Introduction: Bertolotti’s Syndrome, congenital lumbosacral transitional vertebra (LSTV) causing back, hip, groin, sacroiliac, and/or lower extremity pain, is poorly recognized with few studies of diagnosis or treatment. Conservative management rarely results in cure. Injections at the transverse-ala junction have been shown in small series to provide diagnostic clarity. We propose that these injections, when targeted to patients with the above symptoms, predict favorable surgical response.

Methods: A retrospective cohort study was performed from 2020 - 2023 of patients who presented to Jenkins NeuroSpine and received dedicated injections in the LSTV anatomy. VAS pain score and relief duration were recorded. A subanalysis of surgical outcomes for patients who received subsequent Bertolotti’s surgery at Mt. Sinai Hospital was performed.

Results: A total of 56 patients (25 men, 31 women, aged 41.77 ± 17.99) received 22 unilateral and 32 bilateral injections into the transverse ala junction of their LSTV anatomy, performed by 35 practitioners. These patients had previously undergone 61 (average 1.09 injections per patient) prior injections without diagnostic value (less than 50% response). 54 of 56 patients reported improvement with an average pain relief of 87.06% and an average duration of 6.54 days, ranging from 5 minutes to 3 months. Of the 54, 29 patients elected for surgery with 7 decompression and 22 fusion surgeries, and 27 of 29 (93.10%) patients had good relief greater than 50%.

Conclusion : A favorable response, however transient, to lumbosacral intertransverse injections predicts a favorable durable response to surgery (resection and/or fusion surgery, the selection of the treatment based on the anatomic sub-type). With such high sensitivity in patients with transitional anatomy and suggestive symptoms and its predictive value for surgical outcomes, patients with LSTV and suggestive symptoms should be considered for injections to diagnose Bertolotti’s Syndrome, which responds well to surgical management.