Physiotherapists, chiropractors and osteopaths are the practitioners most people with low back pain see first and see most often. This guide covers what a symptomatic lumbosacral transitional vertebra (Bertolotti syndrome) is, how to recognise it, what imaging these professions can request under Medicare, what the biomechanics imply for treatment, what the evidence for manual and exercise therapy shows, when manipulation near the transitional articulation is a concern, and when and how to refer.
A lumbosacral transitional vertebra is present in about one in ten Australians with lumbar radiographs. Most have no pain from it. Among patients with low back pain the condition was present on MRI in 4.6% overall and 11.4% of those under 30. The mean symptom duration in pooled published cases is 41.4 months. The condition is absent from Australian professional guidance and from the Low Back Pain Clinical Care Standard.
The guide sets out the Castellvi and Jenkins classifications, the four proposed pain mechanisms, the history and examination findings described in the specialist literature, sacroiliac provocation testing to separate adjacent pain sources, the differential diagnosis, the Medicare imaging items each profession may request, what to ask the radiologist, a treatment program for a suspected or confirmed transitional segment, the concerns with high-velocity manipulation at the lumbosacral junction, referral pathways, and care after injection or surgery. Every figure is referenced to its source and verification notes appear at the end. It is one of a series of Australian Bertolotti syndrome guides from Clear Mind Press for surgeons, general practitioners, radiologists, emergency clinicians, pain physicians and interventional radiologists, employers and insurers, school sports staff, and family and friends.
