A rare case of low backache (Bertolotti’s syndrome)

Abstract

Lumbosacral transition of L5 vertebra is an anatomical variation. Enlarged transverse process of L5 vertebra may form a pseudo joint with ilium or sacrum. This may lead to low back pain, especially in young adults due to change in biomechanical properties of the lumber spine. This condition is referred to as Bertolotti’s syndrome.

We present a case of 40 years old male surgeon with low backache not responding to oral and intravenous pain killers which prevented him from carrying out his daily routine activities. The pain was severe, excruciating and radiating to right buttock with Visual Analogue Scale (VAS) score ranging from 8/10. There was tenderness over right sacroiliac area provoked by deep palpation. Provisional diagnosis of right sacroilitis was made. Fluoroscopy revealed anomalous articulation between right enlarged L5 transverse process with ipsilateral ala of sacrum forming a pseudo arthrosis with maximum tenderness over it. Periarticular injection at pseudo joint with 0.1 % bupivacaine and of triamcinolone 40 mg was given under fluoroscope and confirmed with dye. There was immediate relief from pain. In young individuals with chronic low back pain diagnosis of Bertolotti’s syndrome should also be kept in mind.

Key words: Low back pain; Bertolotti’s syndrome; Visual Analogue Scale

Citation: Ali L, Ahmad K, Ali U. A rare case of low backache (Bertolotti’s syndrome). Anaesth pain intensive care 2021;25(2):402-405. DOI: doi.org/10.35975/apic.v25i3.1508

Received: May 6, 2021, Reviewed: May 11, 2021, Accepted: May 20, 2021