In this article, Dr. Jenkins and his team assessed the long-term outcomes of 103 patients with Bertolotti's Syndrome that have undergone different surgical approaches; namely spinal fusion with instrumentation (i.e., titanium rod with pedicle screws) or Bertolotti's resection. The team followed up with these patients for at least 6 months after surgery.

Key takeaways:
Based on Dr. Jenkins and team's research, the following surgical procedures yield the most positive outcome for Bertolotti's patients based on their lumbosacral anatomy:
Type I - resection surgery
Type II - Spinal fusion with pedicle screws and rhBMP
Type III - No surgical intervention
Type IV - Unilateral fusion of the 'open' side to create a Type III like anatomy

Patient outcomes based on Jenkins classification is as follows:
Type I:
13 patients total; 12 patients showed good or adequate improvement with resection surgery. One patient did not have any improvement. This patient had other spinal issues that required further intervention (L4-L5 discectomy and L5-S1 fusion)

Type II:
36 patients total; 18 patients had undergone resection surgery with Dr. Jenkins. However, 12 of these patients required subsequent surgical intervention within 2 years of surgery.

The other 18 patients had undergone spinal fusion. 13 patients had more than 50% pain reduction. 3 patients had moderate improvement after initial fusion surgery without pedicle screws. However, all patients symptoms improved after revision surgery to undergo instrumented fusion. Only 2 patients had no improvement.

Most patients did require subsequent intervention despite improvement in their pain due to issues such as Spondylolisthesis, SI joint aggravation, cluneal nerve entrapment.

Type III:
Patients with this anatomy were not operated upon.

Type IV:
7 patients total unilateral instrumented fusion.
6 out of seven patients showed improvement after the open side was fully fused leading to a Type III anatomy. Some of these patients did develop pathology in adjacent segments over time.