We surgically treated 16 patients with Bertolotti's syndrome (chronic, 
persistent low back pain and radiographically diagnosed transitional lumbar 
vertebra). Eight had posterolateral fusion and another eight resection of the 
transitional articulation. Thirteen patients had in addition to the chronic low 
back pain, suffered from repeated episodes or chronic sciatica. In six cases 
with resection treatment, local injections were administered at the transitional 
articulation before deciding for resection of the transitional joint; each 
patient reported transient relief of pain, while this preoperative test did not 
correlate with successful outcome of treatment. Six patients had to be treated 
with second operations. Ten of the 16 operatively treated patients showed 
improvement of the low back pain, and this result was similar in the group 
treated with fusion and in that treated with resection. Seven had no low back 
pain at follow-up, and the improvement according to the Oswestry pain scale was 
similar in the two groups, and statistically significant. Eleven patients still 
had persisting episodes of sciatica (versus 13 preoperatively). The average 
disability according to the Oswestry total disability scale was 30%, 
corresponding with moderate outcome, and both operatively treated groups did 
equally well. At follow-up the first disc above the fused segments was found to 
be degenerated in seven out of eight cases, and in the group treated with 
resection the first disc above the transitional vertebra was degenerated in five 
cases.(ABSTRACT TRUNCATED AT 250 WORDS)