Kawasaki et. al., 2025 summary

For those with Bertolotti's Syndrome, chronic low back pain can be a daily battle. When conservative treatments like physical therapy or medication don't work, surgery is often the next step. But what if that surgery could be done through a tiny incision with a camera?


This case study highlights such a procedure. The paper details the case of a 69-year-old woman who suffered from persistent right-sided low back pain for nine months. Her pain was triggered by simple movements like rolling over or crouching. Imaging confirmed she had Bertolotti's Syndrome, where part of her last lumbar vertebra (L5) formed a "false joint" with her pelvic bone (ilium).


After a diagnostic injection of local anesthetic into this joint provided temporary relief (confirming the pain source), she underwent a procedure called "full endoscopic spine surgery." Using an endoscope—a thin tube with a camera and a light—surgeons were able to go in through a very small opening and remove the piece of bone causing the painful pseudo-articulation.


The result? The patient's low back pain "dramatically resolved" after the surgery, and she was able to go home without any complications.

Key Insights from the Paper

Precision Targeting - A key step before surgery was a diagnostic injection. By injecting an anesthetic into the "false joint" and seeing the pain disappear (even if only for a short time), the doctors confirmed the exact source of the problem. This is a critical step to ensure surgery is targeted correctly.

Minimally Invasive Means Faster Recovery - Unlike traditional open surgery, a full endoscopic approach is less disruptive to the surrounding muscles and tissues leading to a quicker recovery and fewer complications for the patient.

A Viable Alternative to Fusion - For many spinal issues, fusing vertebrae is a common surgical solution. However, this paper shows that for specific cases of BSy where the pain is clearly coming from the abnormal joint, simply resecting (removing) the offending bone can be an effective, motion-preserving alternative.

This case provides a promising look at how modern, minimally invasive techniques can offer significant relief for Bertolotti's Syndrome patients who have not found success with other treatments.