STUDY DESIGN: Case report of surgically treated mechanical low back pain from 
the facet joint contralateral to a unilateral anomalous lumbosacral articulation 
(Bertolotti's syndrome).
OBJECTIVES: To describe the clinical presentation, diagnostic evaluation, and 
management of facet-related low back pain in a 17-year-old cheerleader and its 
successful surgical treatment with resection of a contralateral anomalous 
articulation.
SUMMARY OF BACKGROUND DATA: Lumbosacral transitional vertebrae are common in the 
general population. Bertolotti's syndrome is mechanical low back pain associated 
with these transitional segments. Little is known about the pathophysiology and 
mechanics of these vertebral segments and their propensity to be pain 
generators. Treatment of this syndrome is controversial, and surgical 
intervention has been infrequently reported.
METHOD: A retrospective chart analysis and radiographic review were performed.
RESULTS: Repeated fluoroscopically guided injections implicated a symptomatic 
L6-S1 facet joint contralateral to an anomalous lumbosacral articulation. 
Eventually, a successful surgical outcome was achieved with resection of the 
anomalous articulation.
CONCLUSION: Clinicians should consider the possibility that mechanical low back 
pain may occur from a facet contralateral to a unilateral anomalous lumbosacral 
articulation, even in a young patient. Although reports of surgical treatment of 
Bertolotti's syndrome are infrequent, resection of the anomalous articulation 
provided excellent results in this patient, presumably because of reduced 
stresses on the symptomatic facet.