Treatment of Bertolotti Syndrome : From Concept to Denervation

Bertolotti syndrome is characterized by chronic low back pain caused by transitional lumbosacral vertebrae with a reported pain prevalence of 4.6%–35.6%. The iliolumbar ligament (ILL) has been implicated as one of the primary causes of low back pain due to the unique attachment. There are no nerve fibers within the ILL. However, cadaveric studies have demonstrated the presence of nerve fibers at the attachment to the ilium. We hypothesize that the treatment strategy of Bertolotti syndrome is to interrupt the pain signal transmission by denervating the ILL on both ends rather than on the body of the ligament. We describe our experience of ILL nerve fibers’ denervation with cryoanalgesia in a case report, which sheds light on the novel approach to the management of Bertolotti syndrome.