• How I do it: minimally invasive surgical decompression for lumbosacral extraforaminal stenosis (Far-Out Syndrome)
• Complete, Sustained Resolution of Pain With Pseudoarthrectomy for Bertolotti Syndrome: A Case Report
• Bertolotti syndrome: an often overlooked cause of specific back pain
• A case report of ineffective electroconvulsive therapy for chronic pain
• A Case Study of Bertolotti's Syndrome in an Adolescent Patient
• Channels out of Order: A Review of Central and Peripheral Nervous System Channelopathies
• An update on the prevalence and management of Bertolotti's syndrome
• Oral pharmacological management of Bertolotti syndrome presenting as chronic low back pain - A case report and review of literature

Conservative treatment is the first-line approach in managing Bertolotti syndrome, aiming to relieve pain and improve function before considering surgical options.

• Core strengthening to stabilize the lumbar spine
• Stretching exercises (hamstrings, hip flexors, paraspinal muscles)
• Postural training
• Manual therapy (mobilization/manipulation)

• NSAIDs (e.g., ibuprofen, naproxen) for inflammation and pain control
• Muscle relaxants if there is associated spasm
• Neuropathic agents (e.g., gabapentin) if radicular pain is present

• Corticosteroid + local anesthetic injections into:
  • The pseudoarticulation (if present)
  • Sacroiliac joints
  • Facet joints
• Useful both for therapeutic and diagnostic purposes

• Avoidance of aggravating activities (e.g., heavy lifting, prolonged sitting)
• Ergonomic adaptations at work and home

• CT- or fluoroscopy-guided injections for more accurate targeting
• Consider MRI or CT if symptoms persist to rule out associated pathology

• Referral to a pain or spine specialist if symptoms persist
• Psychological support (e.g., cognitive behavioral therapy) for chronic pain management

• Failure of 3–6 months of well-applied conservative treatment
• Significant functional impairment or persistent radicular symptoms
• Imaging reveals a clear pain generator (e.g., inflammatory pseudoarthrosis)

Some studies advocate surgical resection in selected refractory to more conservative approaches ¹⁾

Goal: To relieve pain by eliminating the pseudoarticulation and addressing associated lumbar disc disease.

• Disconnecting the enlarged lumbar transverse process (TP) pseudojoint from the sacrum
• ✅ Transverse processsectomy:
  • ▪ MIS-paramedian tubular-microsurgical partial resection of the anomalous enlarged TP

A. Disc Herniation

• ✅ Lumbar microdiscectomy combined with transverse processectomy

B. Disc Degeneration

• ✅ Posterolateral fusion (e.g., MIS-TLIF or similar) + transverse processectomy

Complete, Sustained Resolution of Pain With Pseudoarthrectomy for Bertolotti Syndrome: A Case Report ²⁾.