Berlotti's Syndrome It was first diagnosed in 2003 (has only been known for nine years). What is it? It is characterized by an anomalous enlargement of the transverse (B) process of the most caudal lumber vertebra which articulates or fuses with the sacrum or ileum and can cause an isolated L4/5 disc disease. Berlotti's before it was diagnosed was always misinterpreted as low back pain. It also results in pain generating from the 4th lumbar disc resulting in a sciatic type of pain which correlates with the 5th lumbar nerve root. It will have a spatlated transverse process on one side resulting in articulation or partial articulation with the sacrum at time with the ileum or both. The pt will have a limited and altered motion at the lumbar/sacral joint. This loss of motion is then compensated in accelerated degeneration and strain through the L4 disc level which can become symptomatic and inflame the adjacent L5 nerve root resulting in sciatic or radicular pain patterns. This diagnosis is found more in males than females. MRI is the only way to detect this syndrome. It was named after the Italian physician, Mario Bertolotti. He associated these changes with low back pain which he subsequently attributed to arthritic change. It is said to affect 48% of the population. The disc above the transitional vertebra is subject to increased stress which renders the vertebral motion segment hypermobile and prone to early degeneration. The asymmetry of mvt between the transitional vertebrae and the sacrum may accelerate these changes. Berlotti was discovered when a total of 769 consecutive patients with low back pain underwent elective MRI of e lumbo-sacral spine between July 03- Nov 04. Bertlotti was discovered in 383 patients. Usually you treat low back pain with cortisone and or steroid shots but with Bertlotti there is hardly any relief with this.