Treatment Options
"A positive response to a diagnostic injection is currently considered one of the most valuable tools for determining whether the lumbosacral transitional vertebra is the main primary source of pain."
This is when it then becomes Bertolotti Syndrome (BSy).
If you have Bertolotti syndrome (BSy) you will be glad to know that there are options for treatment. Unfortunately there is no “one-size-fits-all” solution and what may work for one person may not work for you.
Treatment really depends on what type of LSTV you have, where your pain is coming from, if you also have secondary pain sources, how severe your symptoms are and other patient specific factors. That is why treatment should always be individualised.
Below we will explore the different management and treatment options available to patients with Bertolotti syndrome (Bsy).
Conservative Treatment
Initial treatment is often conservative in nature with a goal of reducing pain and disability. Treatment may include:
Avoidance of painful activities
Physiotherapy/exercise (Modified)
Core stabilisation/retraining (Modified)
Posture education
Pain-relieving medications that your doctor may recommend
Heat or cold packs
Some patients will find great benefit from these conservative measures, while others will have ongoing pain. But most importantly if exercise/physio therapy hurts then stop as treatment may need modification.
Diagnostic and Treatment Injections
Image-guided injections may be both diagnostic and therapeutic when treating Bertolotti syndrome (BSy).
Injecting a local anaesthetic into the suspected painful pseudoarticulation, SI joint or surrounding structures can help identify whether the transitional segment is the cause of pain. If you experience significant pain relief after this injection it can confirm the diagnosis.
Steroid injections may also provide temporary pain relief by decreasing inflammation around the injected area.
Keep in mind that injections are not always curative. One of their biggest benefits is diagnostic value.
Radiofrequency Ablation
Radiofrequency ablation may be an option for some patients that experience temporary pain relief with diagnostic injections.
This procedure utilises heat generated by radio waves to disrupt pain signals from specific nerves. While some patients report improvement in symptoms after radiofrequency ablation, results have been mixed and more research is needed to determine the long-term benefit of this treatment for Bertolotti syndrome (BSy).
Surgical Management
Surgery may be helpful in patients who have severe or disabling symptoms that have failed to respond to conservative management.
Options for surgery include:
Removal of the pseudoarticulation (“procsesectomy”) in select cases as this can lead to more instability in the spine.
Decompression if there is nerve compression
Spinal fusion in select cases.
Surgical options vary depending on the patients anatomy, where the pain is coming from, spinal stability and any associated degenerative changes especially in adjacent Discs along with age and other Comorbidities.
Keep in mind that surgery is typically considered a last resort when less invasive methods of treatment have failed.
Defining the Cause of Your Pain
Before determining the best course of action it is important to know where your pain is coming from.
Just because you have a lumbosacral transitional vertebra does not mean that it is the cause of your pain. Additionally, not every person with a variant develops pain or symptoms.
A complete clinical examination, appropriate imaging and occasionally diagnostic injections can be used to confirm whether your transitional vertebra is contributing to your symptoms or not.
Seeking a Second Opinion
If you have undergone treatment for back pain and haven’t found relief it may be because your doctor was unaware that you had a lumbosacral transitional vertebra or they think it to be insignificant based on prior learnings.
Since Bertolotti syndrome(BSy) is not widely known in Australia many doctors will misdiagnose patients. If you believe this may have happened to you, don’t be afraid to seek a second opinion from someone who understands LSTV’s.
Finding What Works For You
Every patients story is different. While one person may find success with a specific treatment, that does not mean it will work for you.
Management of Bertolotti syndrome (BSy) may include a combination of treatments and may change over time. Treatment should focus on reducing pain and improving your function and quality of life.
With proper diagnosis and an individualised approach, you can find what works for you and gain your life back!