We surgically treated 16 patients with Bertolotti's syndrome (chronic, persistent low back pain and radiographically diagnosed transitional lumbar vertebra). Eight had posterolateral fusion and another eight resection of the transitional articulation. Thirteen patients had in addition to the chronic low back pain, suffered from repeated episodes or chronic sciatica. In six cases with resection treatment, local injections were administered at the transitional articulation before deciding for resection of the transitional joint; each patient reported transient relief of pain, while this preoperative test did not correlate with successful outcome of treatment. Six patients had to be treated with second operations. Ten of the 16 operatively treated patients showed improvement of the low back pain, and this result was similar in the group treated with fusion and in that treated with resection. Seven had no low back pain at follow-up, and the improvement according to the Oswestry pain scale was similar in the two groups, and statistically significant. Eleven patients still had persisting episodes of sciatica (versus 13 preoperatively). The average disability according to the Oswestry total disability scale was 30%, corresponding with moderate outcome, and both operatively treated groups did equally well. At follow-up the first disc above the fused segments was found to be degenerated in seven out of eight cases, and in the group treated with resection the first disc above the transitional vertebra was degenerated in five cases. As conservatively treated controls, we had 16 comparable, but not randomly chosen patients whose age and type and duration of pain prior to the first clinical examination, and the length of follow-up were similar to those in the operatively treated group. The operatively treated patients had slightly better Oswestry pain score (mean 1.9 versus 2.5; statistically significant), while in regard to the total Oswestry disability scale, the results did not differ. We suggest operative treatment only to very selected patients with Bertolotti's syndrome. Patients with no disc deneration and whose chronic pain is truly associated with the transitional joint may be treated with resection of the transverse process. Patients with similar pain and with degeneration of the disc below but not above the transitional vertebra may have alleviation of pain and disability after posterolateral fusion.
