Mahler Julia, Alfieri Alex
Neurosurgery, Cantonal Hospital of Winterthur, 8400 Winterthur, Switzerland.
Faculty of Biomedical Sciences, Università della Svizzera italiana, 6900 Lugano, Switzerland.
Healthcare (Basel). 2025 Jul 16;13(14):1712. doi: 10.3390/healthcare13141712.
Bertolotti syndrome describes a painful lumbosacral transitional vertebra (LSTV) with a pseudoarticulation between an enlarged lateral process of the caudal lumbar vertebra (L5) and ilium or sacrum. It often presents with chronic lower back pain with or without radiculopathy. The current literature emphasizes Bertolotti as a differential diagnosis in young adults. However, it is presumably underdiagnosed in middle-aged and older patients. Treatment ranges from conservative treatment with physiotherapy, infiltration, and radiofrequency ablation to surgical interventions. : In this case illustration, we present the diagnostic and therapeutic challenges in a 48-year-old female triathlete with persistent left gluteal pain caused by Bertolotti syndrome. When conservative treatment with physiotherapy, infiltrations, thermocoagulation, and radiofrequency ablation of the pseudoarticulation failed, microsurgical reduction of the hypertrophic transverse process was performed. This minimally invasive intervention achieved satisfactory pain relief of at least 70% one year after surgery, allowing the patient to resume her athletic activities. : Bertolotti syndrome should be considered a potential differential diagnosis in patients of all ages. Since many patients endure years of misdiagnosis, adequate treatment is crucial upon diagnosis. If conservative measures fail, surgical treatment such as "processectomy" or spinal fusion should be evaluated. This case follows the CARE reporting guidelines.
贝托洛蒂综合征描述的是一种伴有疼痛的腰骶部移行椎（LSTV），在尾侧腰椎（L5）增大的横突与髂骨或骶骨之间存在假关节。它常表现为伴有或不伴有神经根病的慢性下腰痛。当前文献强调贝托洛蒂综合征是年轻成年人的鉴别诊断之一。然而，据推测在中年及老年患者中该综合征存在诊断不足的情况。治疗方法包括物理治疗、注射、射频消融等保守治疗以及手术干预。在本病例报告中，我们展示了一名48岁女性三项全能运动员因贝托洛蒂综合征导致持续性左臀痛所面临的诊断和治疗挑战。当对假关节进行物理治疗、注射、热凝和射频消融等保守治疗均失败后，对肥大的横突进行了显微手术复位。这种微创干预在术后一年实现了至少70%的满意疼痛缓解，使患者能够恢复其体育活动。贝托洛蒂综合征应被视为所有年龄段患者的潜在鉴别诊断。由于许多患者多年来一直被误诊，确诊后进行充分治疗至关重要。如果保守措施失败，应评估诸如“横突切除术”或脊柱融合等手术治疗方法。本病例遵循CARE报告指南。
