Published: 2022-08-29

Unilateral enlarged and bifid transverse process of an atypical lumbar vertebra: a case study

Gyanaranjan Nayak


Sometimes the atypical lumbar vertebra (L5) may articulate with underlying bones like ilium and sacrum. This may give rise to low back pain in the concerned subject. An atypical lumbar vertebra with unilateral bifid transverse process was encountered by the author during routine osteology classes of MBBS students and it was thoroughly examined. On gross examination of the said vertebra, a facet measuring 1.9 cm in maximum length and 0.8 cm in maximum breadth could be observed on the inferior surface of the anterior part of the bifid transverse process. The altered morphology of the vertebra indicates the possible articulation of its transverse process with the underlying ilium or sacrum leading to low back pain (probable cause of Bertolotti’s syndrome).



Bertolotti’s syndrome, Backache, Lumbosacral transitional vertebra

Full Text:



Crane J, Cragin R, O’ Neill J, Berger AA, Kassem H, Sherman WF, et al. A comprehensive update of the treatment and management of Bertolotti’s syndrome: a best practices review. Orthop Rev (Pavia). 2021;13(2):24980.

Jain A, Agarwal A, Jain S, Shamshery C. Bertolotti’s syndrome: a diagnostic and management dilemma for pain physicians. Korean J Pain. 2013;26(4):368-73.

Alonzo F, Colbar A, Cahueque M, Preito JA. Bertolotti’s syndrome: an underdiagnosed cause for low back pain. J Surg Case Reports. 2018;2018(10).

Peterson CK, Bolton J, Hsu W, Wood A. A cross-sectional study comparing pain and disability levels in patients with low back pain with and without transitional lumbosacral vertebrae. J Manipulative Physiol Ther. 2005;28(8):570-4.

Fairbank JCT, Pynsent PB. The oswerty disability index. Spine. 2000;25(22):2440-52.

Smeets R, Koke A, Lin CW, Ferreira M, Demoulin C. Measures of function in low back pain/disorders: low back pain rating scale (LBRPS), Oswerty disability index (ODI), progressive isoinertial lifting evaluation (PILE), Quebec back pain disability scale (QBPDS), and Roland-morris disability questionnare. Arthritis Care Res. 2011;63(11):158-73.

Manmohan S, Dzulkarnain A, NorAzlin ZA, Fazir M. Bertolotti’s syndrome: a commonly missed cause of back pain in young patients. Off J Acad Fam Physicians Malaysia. 2015;10(2):55-8.

Larossa R, Mellado JM, Solana SS, Yanguas N, Martin J, Cozcolleula M. Anatomical variations and congenital anomalies of the lumbar vertebrae:64-Slice MDCT appearance. Sem Scholar. 2011.