title: Bertolotti syndrome: a diagnostic and management dilemma for pain physicians.
abstract: BACKGROUND
  Bertolotti's syndrome (BS), a form of lumbago in lumbosacral transitional vertebrae, is an important cause of low back pain in young patients. The purpose of this study was to assess the etiology of low back pain and the efficacy of treatment offered to patients with BS.
  
  
  METHODS
  All patients of BS Castellvi type1a during a period of 6 months were enrolled in the study. The patients underwent interventional pain procedures for diagnosis and pain relief. Response to the therapy was assessed based on VAS and ODI scores. A 50% decrease in VAS score or a VAS score less than 3 would be considered adequate pain relief.
  
  
  RESULTS
  All 20 patients diagnosed with BS during the 6-month observation period had scoliosis. Common causes of back pain were the ipsilateral L5-S1 facet joint, neoarticulation, the SI joint, and disc degeneration. Responses to various interventions for pain relief were different and inconsistent from patient to patient. In particular, responses to interventions for neoarticular pain were generally poor.
  
  
  CONCLUSIONS
  Pain in patients with BS does not usually respond to interventional pain treatment. A very dynamic treatment approach must be pursued while managing BS patients, and the treatment plan must be individualized at various stages in order to obtain satisfactory pain relief.
authors.affiliation: Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Anuj
authors.initials: A
authors.lastname: Jain
authors.forename: Anil
authors.initials: A
authors.lastname: Agarwal
authors.forename: Suruchi
authors.initials: S
authors.lastname: Jain
authors.forename: Chetna
authors.initials: C
authors.lastname: Shamshery
keywords: Bertolotti's syndrome; low back pain; scoliosis