J Rheum Dis.  2020 Jul;27(3):209-212. 10.4078/jrd.2020.27.3.209.

Bertolotti’s Syndrome Requiring Intervention for Lower Back Pain: Two Cases Suspected as Ankylosing Spondylitis

• Kang J
• Lee S
• Kim TH

• KMID: 2504036
• DOI: http://doi.org/10.4078/jrd.2020.27.3.209

Abstract

Bertolotti’s syndrome is the part of lumbosacral transitional vertebra and is a congenital anomaly of the axial spine. The syndrome is associated with changes in the sacrum or iliac crest and secondary arthritis and is often mistaken for ankylosing spondylitis (AS). The mechanism of pain in this disease is unclear, and treatments have not been accurately established. Here, we report two cases of Bertolotti’s syndrome in patients with severe back pain who were initially suspected to have AS and required interventional procedures. The two young adult patients developed symptoms similar to those of inflammatory back pain, and their symptoms did not improve with conventional treatment alone. Both patients underwent interventional management, and the symptoms improved. It may be clinically helpful to confirm the presence of Bertolotti’s syndrome in patients with suspected AS, and interventional therapy may be required in some cases.

Keyword

Bertolotti’s syndrome; Ankylosing spondylitis; Lower back pain; Intervention

Figure

• 

  Figure 1 Diagnostic and interventional images of patient 1. Pelvis anteriorposterior (AP) radiograph showing a lumbosacral transition vertebra and the left upper border of sacrum are articulate (white arrow) (A), oblique coronal corresponding T2-weighted image of the sacral ala and the lower lumbar vertebra showing an inflammatory pseudoarthrosis (white arrow) between the left transverse process of L5 vertebra and the ala of sacrum (B) and fluoroscopic image of a contrast injection and steroid injection into an articulation between the left L5 to S1 transitional vertebra (C).

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  Figure 2 Diagnostic and interventional images of patient 2. Pelvis anteriorposterior (AP) radiograph showing a left lumbosacral transition vertebra (white arrow) (A), an increased uptake (black arrow) is observed in the upper portion of the left sacroiliac joint in the delayed whole body bone scan image (B) and focal uptake in left transitional vertebra (white arrow) in single-photon emission computed tomography (SPECT) image (C). Fluoroscopic image of a contrast injection and steroid injection into between enlarged left transverse process and sacrum (D).

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