Bertolotti’s Syndrome: An Overlooked Cause of Chronic Low Back Pain

When patients experience chronic low back pain—especially at a younger age—it’s often misattributed to muscle strain, herniated discs, or degenerative disc disease. However, there’s another lesser-known condition that may be the underlying cause: Bertolotti’s Syndrome. Dr. Craig C. Callewart, MD, a board-certified spine surgeon in Dallas, specializes in diagnosing and treating this often-overlooked source of back pain. 

What Is Bertolotti’s Syndrome?

Bertolotti’s Syndrome is a congenital condition in which the lowest lumbar vertebra (L5) has an abnormal connection—or transitional vertebra—to the sacrum or pelvis. This connection may be partial or complete and can create abnormal motion, stress, or stiffness in the lower spine, leading to localized pain or nerve irritation.

It’s considered a structural abnormality, often present from birth, but symptoms may not appear until adolescence or early adulthood.

Common Symptoms

Patients with Bertolotti’s Syndrome may experience:

• Persistent low back pain, often one-sided
• Pain that worsens with activity or prolonged sitting
• Discomfort radiating into the hips or buttocks
• Occasionally, sciatica-like symptoms if nerves are compressed

This condition can often mimic other lumbar spine issues, which is why it’s frequently misdiagnosed or undiagnosed altogether.

Diagnosing Bertolotti’s Syndrome

Diagnosis begins with a thorough evaluation and advanced imaging, including X-rays, CT scans, or MRI. Dr. Callewart looks specifically for the transitional vertebra and its articulation with the sacrum or ilium.

Sometimes, a diagnostic injection into the pseudo-joint (where the abnormal bone connection exists) is used to confirm that this region is the source of pain.

Treatment Options

Dr. Callewart believes in conservative management first, especially for younger patients. Treatment options may include:

• Physical therapy to strengthen surrounding muscles and improve mobility
• Anti-inflammatory medications or targeted injections
• Image-guided steroid injections to reduce inflammation around the pseudo-joint
• Radiofrequency ablation to disable pain-causing nerves in select cases

If conservative treatments fail, and symptoms persist or worsen, surgical options may be considered. These can include:

• Resection of the transitional articulation (removing the pseudo-joint)
• Spinal fusion in rare cases when instability is present

Dr. Callewart carefully evaluates each case to determine the most appropriate and least invasive solution for long-term relief.

Why Choose Dr. Craig C. Callewart, MD for Bertolotti’s Syndrome?

As an independent spine surgeon, Dr. Callewart offers:

• Decades of experience in diagnosing complex and rare spine conditions
• Advanced imaging and diagnostic tools to pinpoint the cause of pain
• A conservative-first treatment philosophy
• Direct, personalized care in a patient-centered setting

Schedule a Consultation

If you’ve been living with chronic low back pain and haven’t found lasting relief, Bertolotti’s Syndrome could be the missing diagnosis. Dr. Callewart is committed to helping patients uncover the true source of their pain and return to a more active, comfortable life.

📞 Call (214) 271-4585 or visit www.c3spine.com to schedule a consultation with Dr. Craig C. Callewart, MD.