Hauser Anna-Lena, Von Glinski Alexander, Noriega Urena Javier Fernando, Lange Tobias, Murad Samira, Lewik Guido, Schulte Tobias
St. Josef-Hospital Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
Orthopadie (Heidelb). 2025 Apr 29. doi: 10.1007/s00132-025-04656-1.
Lumbosacral transitional vertebrae (LSTV) are common, with a prevalence of 15-35%, and can be a cause of specific low back pain. The insufficient awareness of this anomaly often leads to delayed diagnosis and treatment.
This study explains the anatomical and biomechanical basis of Bertolotti syndrome and discusses diagnostic and therapeutic options.
This systematic review was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The SCOPE criteria (Structuring Comparative Outcome Reporting in Epidemiology) were considered to ensure comprehensive and transparent reporting. A systematic search was performed in PubMed using the search terms 'Bertolotti', 'Bertolotti syndrome', and 'Lumbosacral transitional vertebrae' by a single investigator, resulting in the inclusion of 112 studies. Articles that were not available in English or German were excluded.
Patients with symptomatic Bertolotti syndrome often suffer from chronic low back pain and radiculopathies. Imaging techniques, particularly X‑rays and MRI, play a key role in diagnosis. Conservative treatments show limited success. Surgical resection of the transverse process (processectomy), especially after positive test infiltrations, leads to significant pain relief, particularly in younger patients without degenerative changes.
Treatment choice depends on individual anatomy and the presence of degenerative changes. While conservative measures are initially recommended, processectomy shows promising results in carefully selected patients. Fusion surgeries should only be considered in cases of instability. Further studies are needed to confirm the effectiveness of invasive procedures.
腰骶部移行椎（LSTV）很常见，患病率为15% - 35%，可能是特定下腰痛的原因。对这种异常认识不足常导致诊断和治疗延迟。
本研究解释贝托洛蒂综合征的解剖学和生物力学基础，并讨论诊断和治疗选择。
本系统评价按照PRISMA指南（系统评价和Meta分析的首选报告项目）进行。考虑了SCOPE标准（流行病学中构建比较结果报告）以确保全面和透明的报告。由一名研究者在PubMed中使用搜索词“贝托洛蒂”、“贝托洛蒂综合征”和“腰骶部移行椎”进行系统检索，共纳入112项研究。排除非英文或德文的文章。
有症状的贝托洛蒂综合征患者常患有慢性下腰痛和神经根病。影像学技术，尤其是X线和MRI，在诊断中起关键作用。保守治疗效果有限。横突切除术（椎板切除术），尤其是在试验性浸润阳性后，可显著缓解疼痛，特别是在没有退行性改变的年轻患者中。
治疗选择取决于个体解剖结构和是否存在退行性改变。虽然最初建议采取保守措施，但椎板切除术在精心挑选的患者中显示出有希望的结果。仅在不稳定的情况下才应考虑融合手术。需要进一步研究以证实侵入性手术的有效性。
