OBJECTIVE: Bertolotti's syndrome is a spine disorder characterized by the 
occurrence of a congenital lumbar transverse mega-apophysis in a transitional 
vertebral body that usually articulates with the sacrum or the iliac bone. It 
has been considered a possible cause of low back pain.
METHOD: We analyzed the cases of Bertolotti's syndrome that failed clinical 
treatment and reviewed the literature concerning this subject.
RESULTS: Five patients in our series had severe low back pain due to the 
neo-articulation and two of them were successfully submitted to surgical 
resection of the transverse mega-apophysis. Taking into account the clinical and 
surgical experience acquired with these cases, we propose a 
diagnostic-therapeutic algorithm.
CONCLUSION: There is still no consensus about the most appropriate therapy for 
Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the 
source of back pain, surgical resection may be a safe and effective procedure.