This 20-year-old, female U-20 national team player presented with a three-month history of left sided low back pain. This was not associated with any trauma and came on insidiously. The pain was made worse by activity and improved by rest. On examination, she had tenderness over the lower lumbar spine in the midline and had pain with lumbar extension.
A coned AP image of the lower lumbar spine shows a transitional L5 vertebrae which is sacralised on the left. The transverse process on the right is normal. Subsequent MRI imaging shows four lumbar-type vertebrae. There is incomplete sacralisation of L5 with a broadened left transverse process. This forms a pseudo articulation with the left sacral ala. There is no bone marrow oedema on either side of the pseudo arthrosis.
This player was successfully managed with a short period of rest followed by a return to training and match play. She has continued to experience low-grade, episodic lumbar pain which has largely been controlled with a stretching and core stability programme.
Bertolotti’s syndrome is a relatively uncommon cause of low back pain that occurs due to sacralisation of the lowest lumbar vertebral body or lumbarisation of the uppermost sacral segment. It is a congenital condition that does not usually become symptomatic until players enter their twenties. The most commonly reported symptoms are low back and buttock pain while radicular symptoms can also occur. In most cases the transitional vertebra can be seen on AP x-rays as a “spatulated” transverse process. This can be associated with increased signal on T2 MRI sequences. The pseudo articulation can lead to restricted or altered motion at the lumbo-sacral articulation which can either cause pain directly or create stress at the L4 disc level.
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.