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.