Bertolotti’s Syndrome Treatment in Beverly Hills

What Is Bertolotti’s Syndrome?

Bertolotti's syndrome is low back and hip pain that comes from a transitional vertebra at the bottom of the lumbar spine. In some people, the lowest lumbar vertebra has an enlarged transverse process that forms an extra, often oversized joint with the sacrum or pelvis. That abnormal joint and the altered mechanics around it can become a genuine pain source.

A transitional vertebra is a common anatomical variant, and many people who have one never feel a thing. It only becomes Bertolotti's syndrome when that segment is actually generating pain. Because the discomfort sits low in the back and often spreads into the hip or buttock, it is frequently mistaken for ordinary disc or sacroiliac pain — which is why careful, targeted diagnosis is the key to getting it right.

Chronic Back Pain, Stiffness, or Nerve Irritation

• ✓Chronic low back pain centered low, near the belt line
• ✓Pain that spreads into the hip or buttock, often on one side
• ✓Discomfort that worsens with standing, twisting, or bending to the side
• ✓Tenderness over the enlarged joint next to the spine
• ✓Pain that has been mistaken for disc or sacroiliac problems

The Lumbosacral Transitional Vertebra

• A transitional lumbosacral vertebra present from birth
• An enlarged transverse process forming an extra joint with the sacrum or pelvis
• Abnormal loading and motion at that false joint
• Arthritis developing within the transitional joint over time
• Extra stress transferred to the disc just above the transitional level

Why Bertolotti’s Syndrome Is Often Misdiagnosed

The challenge with Bertolotti's syndrome is proving that the transitional segment is the true pain source rather than an incidental finding. Dr. Melamed reviews X-rays and MRI to identify the transitional anatomy and any arthritis in the false joint, and a targeted, image-guided diagnostic injection into that joint is often the deciding test: meaningful, temporary relief points strongly to the transitional segment as the culprit. That confirmation is what prevents treating the wrong level.

Endoscopic CT-Guided Bertolotti Release

Treatment for Bertolotti's syndrome starts conservatively and is guided by what the diagnostic workup shows. Physical therapy, activity adjustments, anti-inflammatory measures, and image-guided injections into the transitional joint can control symptoms for many people, and injections do double duty by confirming the pain source.

When pain is clearly localized to the transitional joint and injections give real but temporary relief, Dr. Melamed can remove the problem directly. He performs an endoscopic, CT-guided, navigated resection that he developed: through an incision under 1 cm, with CT imaging and navigation during the procedure, he removes the bone forming the false joint. It is done as an outpatient procedure, usually under local anesthesia with light sedation, with no fusion and a recovery plan built to avoid narcotics. In select cases with true instability, a limited stabilization may be the better option. Patient selection, treating only a confirmed pain source, matters as much as the technique.