{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:01Z","timestamp":1776096361835,"version":"3.50.1"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,16]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Bertolotti syndrome is an underrecognized cause of chronic low back pain. Back pain generated from Bertolotti syndrome is believed to result from altered weight dissipation mechanics and\/or instability of the pseudoarticulation, while local nerve root compression may result in radiculopathy. Here, the authors describe the findings of a patient with treatment-refractory low back pain found to have a cystic lesion arising from a Bertolotti joint causing L5 nerve root compression. To their knowledge, this has not been previously described in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Despite early recognition of Bertolotti syndrome, the patient\u2019s back pain remained resistant to many years of both conservative and surgical management. The novel finding of a cyst arising from the pseudoarticulation complicated the management. The patient is scheduled to undergo further surgery this year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case highlights a pseudocyst associated with a Bertolotti joint. The cyst introduced additional clinical uncertainty to what is already an uncommon and difficult to treat condition. Resection of the Bertolotti joint failed to improve the patient\u2019s symptoms. Postoperatively, a complex hemorrhagic pseudocyst was seen on imaging, possibly due to the pseudoarticulation with persistent motion. Ongoing efforts to characterize Bertolotti syndrome and its associated imaging findings are necessary to better optimize management strategies in these patients.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25948\">https:\/\/thejns.org\/doi\/10.3171\/CASE25948<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25948","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:13:00Z","timestamp":1773925980000},"source":"Crossref","is-referenced-by-count":0,"title":["Bertolotti joint\u2013related cyst: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"William D.","family":"Chow","sequence":"first","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0443-7763","authenticated-orcid":true,"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly K.","family":"Amrami","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin D.","family":"Elder","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael P.","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","article-title":"Bertolotti syndrome","author":"Miller","unstructured":"Miller AEZhang A.Bertolotti syndrome. 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Int J Spine Surg. 2015;9:42. doi:10.14444\/2042"},{"issue":"10","key":"bib4","series-title":"AJNR, Am J Neuroradiol","first-page":"1778","article-title":"Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance","volume":"31","author":"Konin","year":"2010","unstructured":"Konin GPWalz DM.Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR, Am J Neuroradiol. 2010;31(10):1778-1786. doi:10.3174\/ajnr.A2036"},{"issue":"46","key":"bib5","series-title":"Orv Hetil","first-page":"2537","article-title":"Clinical significance of lumbosacral transitional vertebrae (Bertolotti syndrome)","volume":"134","author":"Barz\u00f3","year":"1993","unstructured":"Barz\u00f3 PV\u00f6r\u00f6s EBodosi M.Clinical significance of lumbosacral transitional vertebrae (Bertolotti syndrome). Article in Hungarian. Orv Hetil. 1993;134(46):2537-2540."},{"issue":"9","key":"bib6","series-title":"J Bone Joint Surg Br","first-page":"1183","article-title":"Bertolotti\u2019s syndrome. A cause of back pain in young people","volume":"88","author":"Quinlan","year":"2006","unstructured":"Quinlan JFDuke DEustace S.Bertolotti\u2019s syndrome. A cause of back pain in young people. J Bone Joint Surg Br. 2006;88(9):1183-1186. doi:10.1302\/0301-620X.88B9.17211"},{"issue":"4","key":"bib7","series-title":"Bull Hosp Jt Dis","first-page":"191","article-title":"Lumbosacral transitional vertebrae and low back pain","volume":"58","author":"Dai","year":"1999","unstructured":"Dai L.Lumbosacral transitional vertebrae and low back pain. Bull Hosp Jt Dis. 1999;58(4):191-193."},{"issue":"2","key":"bib8","series-title":"Radiology","first-page":"497","article-title":"Lumbosacral transitional vertebrae: association with low back pain","volume":"265","author":"Nardo","year":"2012","unstructured":"Nardo LAlizai HVirayavanich WLumbosacral transitional vertebrae: association with low back pain. 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Arch Orthop Trauma Surg. 1993;112(2):82-87. doi:10.1007\/BF00420261"},{"issue":"5","key":"bib14","series-title":"J Neurosurg Spine","first-page":"700","article-title":"Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature","volume":"24","author":"Burke","year":"2016","unstructured":"Burke JFThawani JPBerger IMicrosurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature. J Neurosurg Spine. 2016;24(5):700-707. doi:10.3171\/2015.9.SPINE153"},{"issue":"7","key":"bib15","series-title":"J NeuroIntervent Surg","first-page":"737","article-title":"Interventional approaches to symptomatic Tarlov cysts: a 15-year institutional experience","volume":"16","author":"Tracz","year":"2024","unstructured":"Tracz JJudy BFJiang KJInterventional approaches to symptomatic Tarlov cysts: a 15-year institutional experience. J NeuroIntervent Surg. 2024;16(7):737-741. doi:10.1136\/jnis-2023-020564"},{"key":"bib16","series-title":"World Neurosurg","first-page":"e1059","article-title":"Synovial cyst as a marker for lumbar instability: a systematic review and meta-analysis","volume":"122","author":"Ramhmdani","year":"2019","unstructured":"Ramhmdani SIshida WPerdomo-Pantoja AWitham TFLo SLBydon A.Synovial cyst as a marker for lumbar instability: a systematic review and meta-analysis. World Neurosurg. 2019;122:e1059-e1068. doi:10.1016\/j.wneu.2018.10.228"},{"issue":"9","key":"bib17","series-title":"Spine J","first-page":"820","article-title":"Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes","volume":"10","author":"Bydon","year":"2010","unstructured":"Bydon AXu RParker SLRecurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. 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J Med Case Rep. 2012;6(1):337. doi:10.1186\/1752-1947-6-337"},{"issue":"15","key":"bib23","series-title":"Spine (Phila Pa 1976)","first-page":"E528","article-title":"Surgical approach for synovial cyst of the atlantoaxial joint: a case report and review of the literature","volume":"34","author":"Marbacher","year":"2009","unstructured":"Marbacher SLukes AVajtai IOzdoba C.Surgical approach for synovial cyst of the atlantoaxial joint: a case report and review of the literature. Spine (Phila Pa 1976). 2009;34(15):E528-E533. doi:10.1097\/BRS.0b013e3181ab22c3"},{"key":"bib1","article-title":"Bertolotti syndrome","author":"Miller","unstructured":"Miller AEZhang A.Bertolotti syndrome. In: StatPearls. StatPearls Publishing; 2025. Accessed August 10, 2025. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK585032\/"},{"issue":"5","key":"bib2","series-title":"Spine (Phila Pa 1976)","article-title":"Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects","volume":"9","author":"Castellvi","year":"1984","unstructured":"Castellvi AEGoldstein LAChan DPK.Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976). 1984;9(5):493-495. doi:10.1097\/00007632-198407000-00014"},{"key":"bib3","series-title":"Int J Spine Surg","first-page":"42","article-title":"A review of symptomatic lumbosacral transitional vertebrae: Bertolotti\u2019s syndrome","volume":"9","author":"Jancuska","year":"2015","unstructured":"Jancuska JMSpivak JMBendo JA.A review of symptomatic lumbosacral transitional vertebrae: Bertolotti\u2019s syndrome. Int J Spine Surg. 2015;9:42. doi:10.14444\/2042"},{"issue":"10","key":"bib4","series-title":"AJNR, Am J Neuroradiol","first-page":"1778","article-title":"Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance","volume":"31","author":"Konin","year":"2010","unstructured":"Konin GPWalz DM.Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR, Am J Neuroradiol. 2010;31(10):1778-1786. doi:10.3174\/ajnr.A2036"},{"issue":"46","key":"bib5","series-title":"Orv Hetil","first-page":"2537","article-title":"Clinical significance of lumbosacral transitional vertebrae (Bertolotti syndrome)","volume":"134","author":"Barz\u00f3","year":"1993","unstructured":"Barz\u00f3 PV\u00f6r\u00f6s EBodosi M.Clinical significance of lumbosacral transitional vertebrae (Bertolotti syndrome). Article in Hungarian. Orv Hetil. 1993;134(46):2537-2540."},{"issue":"9","key":"bib6","series-title":"J Bone Joint Surg Br","first-page":"1183","article-title":"Bertolotti\u2019s syndrome. A cause of back pain in young people","volume":"88","author":"Quinlan","year":"2006","unstructured":"Quinlan JFDuke DEustace S.Bertolotti\u2019s syndrome. A cause of back pain in young people. J Bone Joint Surg Br. 2006;88(9):1183-1186. doi:10.1302\/0301-620X.88B9.17211"},{"issue":"4","key":"bib7","series-title":"Bull Hosp Jt Dis","first-page":"191","article-title":"Lumbosacral transitional vertebrae and low back pain","volume":"58","author":"Dai","year":"1999","unstructured":"Dai L.Lumbosacral transitional vertebrae and low back pain. Bull Hosp Jt Dis. 1999;58(4):191-193."},{"issue":"2","key":"bib8","series-title":"Radiology","first-page":"497","article-title":"Lumbosacral transitional vertebrae: association with low back pain","volume":"265","author":"Nardo","year":"2012","unstructured":"Nardo LAlizai HVirayavanich WLumbosacral transitional vertebrae: association with low back pain. Radiology. 2012;265(2):497-503. doi:10.1148\/radiol.12112747"},{"issue":"3","key":"bib9","series-title":"J Neurosurg Spine","first-page":"283","article-title":"Minimally invasive tubular resection of the anomalous transverse process in patients with Bertolotti\u2019s syndrome:","volume":"20","author":"Li","year":"2013","unstructured":"Li YLubelski DAbdullah KGMroz TESteinmetz MP.Minimally invasive tubular resection of the anomalous transverse process in patients with Bertolotti\u2019s syndrome: presented at the 2013 Joint Spine Section Meeting: clinical article.J Neurosurg Spine. 2013;20(3):283-290. doi:10.3171\/2013.11.SPINE13132"},{"issue":"10","key":"bib10","series-title":"Int J Surg","first-page":"3159","article-title":"A systematic review and bibliometric study of Bertolotti\u2019s syndrome: clinical characteristics and global trends","volume":"109","author":"Zhu","year":"2023","unstructured":"Zhu WDing XZheng JA systematic review and bibliometric study of Bertolotti\u2019s syndrome: clinical characteristics and global trends. 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Pain Physician. 2024;27(2):E275-E284. doi:10.36076\/ppj.2024.27.E275"},{"key":"bib13","series-title":"World Neurosurg","first-page":"e311","article-title":"Operative treatment of Bertolotti syndrome: resection versus fusion","volume":"165","author":"Mikula","year":"2022","unstructured":"Mikula ALLakomkin NRansom RCOperative treatment of Bertolotti syndrome: resection versus fusion. World Neurosurg. 2022;165:e311-e316. doi:10.1016\/j.wneu.2022.06.042"},{"issue":"2","key":"bib25","series-title":"Follow-up of 16 patients. Arch Orthop Trauma Surg","first-page":"82","article-title":"Surgical treatment of Bertolotti\u2019s syndrome","volume":"112","author":"Santavirta","year":"1993","unstructured":"Santavirta STallroth KYlinen PSuoranta H.Surgical treatment of Bertolotti\u2019s syndrome. Follow-up of 16 patients. 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