Síndrome de Bertolotti: Una Causa de Dolor Lumbar a Considerar

Introduction: Bertolotti’s syndrome is an underrecognized cause of chronic low back pain associated with the presence of a lumbosacral transitional vertebra. Its diagnosis is often delayed due to symptom overlap with other causes of low back pain and its limited inclusion in diagnostic algorithms. Case presentation: We report the case of a 30-year-old female who presented to the emergency department with severe low back pain radiating to the right lower limb, accompanied by paresthesia, with a two-month history refractory to conventional analgesic treatment. Physical examination revealed a positive Lasègue test and localized tenderness in the right lumbosacral region. Lumbosacral radiography demonstrated an elongated transverse process of L5 consistent with a lumbosacral transitional vertebra, classified as Castellvi type IIb. The patient was referred for pain management and neurosurgical evaluation. Discussion: Bertolotti’s syndrome represents a diagnostic challenge due to its nonspecific clinical presentation and low clinical suspicion. Altered spinal biomechanics associated with lumbosacral transitional vertebrae may contribute to early degenerative changes and chronic pain. Management should follow a stepwise approach, beginning with conservative treatment and considering interventional or surgical options in refractory cases. Conclusion: This case highlights the importance of including Bertolotti’s syndrome in the differential diagnosis of low back pain in young patients, particularly in those with persistent symptoms despite standard treatment, to allow timely diagnosis and appropriate management.