<span class="word">A <span class="word"><span class="changedDisabled">Modern <span class="word"><span class="changedDisabled">Perspective <span class="word">on <span class="word">Bertolotti’s <span class="word">Syndrome: <span class="word"><span class="changedDisabled">Etiology, <span class="word">Classification, <span class="word"><span class="changedDisabled">Diagnosis, <span class="word">and <span class="word"><span class="changedDisabled">Treatment

Bertolotti's Syndrome is a congenital condition characterized by chronic low back pain stemming from a lumbosacral transitional vertebra (LSTV). While LSTV anatomy is present in approximately 20% of the population, the syndrome is clinically defined only when the LSTV is confirmed as the pain generator. This review synthesizes the latest understanding of the condition, ranging from its genetic origins in HOX gene patterning defects to modern clinical management. We examine the biomechanical alterations caused by LSTV and discuss the advantages of Jenkins classification over Castellvi classification. The diagnostic protocol is presented as a multi-step process, emphasizing the necessity of fluoroscopy-guided diagnostic injections to distinguish incidental findings from true pathology. Finally, we present the consensus treatment protocol based on latest findings and identify critical gaps in the literature regarding standardized care protocols and long-term surgical outcomes.