Bertolotti's Syndrome Endoscopic Resection

What is Bertolotti's Syndrome Endoscopic Resection?

Bertolotti's syndrome is pain that comes from a lumbosacral transitional vertebra. In some people the lowest lumbar vertebra grows an oversized wing of bone (the transverse process) that meets the sacrum or pelvis and forms a false joint. Plenty of people have that anatomy and feel nothing. For others, the false joint wears, gets inflamed, and becomes a steady source of low back, hip, and buttock pain that is easy to mistake for a disc or sacroiliac problem.

The usual surgical answers have been an open resection of the enlarged bone or a fusion of the segment. Both are large operations for a problem that sits in one small spot. Dr. Melamed developed a smaller option: an endoscopic, CT-guided, navigated resection. CT imaging taken in the operating room maps the false joint in three dimensions, navigation tracks his instruments against that map, and an endoscope passed through a single incision under 1 cm lets him remove the bone that forms the joint while the surrounding muscle is left in place.

This is a procedure he performs, not just a condition he diagnoses. Patients travel to Beverly Hills for it from across the country and abroad, often after years of being told their pain was coming from somewhere else.

Am I a candidate for Bertolotti's Syndrome Endoscopic Resection?

You may be a candidate if imaging (X-ray, MRI, or CT) shows a transitional vertebra with a false joint, your pain sits low in the back or spreads into the hip or buttock on that side, and physical therapy or injections have not given lasting relief.

Confirming the source matters more than anything else here. A transitional vertebra can be an incidental finding, so Dr. Melamed often uses a targeted, image-guided injection into the false joint as a test. Real but temporary relief from that injection points strongly to the joint as the pain generator. If the pain is really coming from a disc, a nerve, or the sacroiliac joint, removing the false joint would not help, and he will tell you so.

How does Bertolotti's Syndrome Endoscopic Resection work?

The procedure is done as an outpatient case. In most patients it is performed under local anesthesia with light sedation rather than general anesthesia.

A CT scan taken at the start of the procedure shows exactly where the enlarged transverse process meets the pelvis. Navigation links that scan to Dr. Melamed's instruments, so he can see their position against your anatomy in real time. Through an incision under 1 cm, he passes a high-definition endoscope down to the false joint and removes the bone that forms it, releasing the abnormal connection and unloading the joint.

Nothing is fused and no hardware is left behind. The small incision is closed at the end, and most patients walk out the same day.

What is recovery like?

Recovery is built around Dr. Melamed's narcotic-sparing protocol, and many patients need no narcotic pain medication after the procedure. Most can drive within a day or so, return to desk work within days depending on the job, and build back to sports and full activity over about a month. He will give you a timeline for your case before the procedure, and a physically demanding job may need more time.

What are the benefits of Bertolotti's Syndrome Endoscopic Resection?

• ✓Incision under 1 cm, with the back muscles left in place
• ✓CT guidance and navigation during the procedure for precise targeting
• ✓Outpatient, usually under local anesthesia with light sedation
• ✓No fusion and no implanted hardware
• ✓Recovery plan built to avoid narcotics
• ✓A technique Dr. Melamed developed

What conditions does Bertolotti's Syndrome Endoscopic Resection treat?

• Bertolotti's syndrome (lumbosacral transitional vertebra) confirmed as the pain source
• Low back, hip, or buttock pain coming from the false joint
• Arthritis and inflammation inside the transitional joint
• Pain that returns after injections into the false joint wear off