• Ansh Desai, Derrick Obiri-Yeboah, Kyle McGrath, Jamie Sheehan, Jeremy Loss, John D Reith, and Michael P Steinmetz.
• Center for Spine Health, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: add75@case.edu.
• World Neurosurg. 2024 Sep 1; 189: e267e271e267-e271.

BackgroundBertolotti syndrome (BS) is characterized by chronic pain and functional impairment associated with lumbosacral transitional vertebrae (LSTVs). The study aimed to investigate the histologic characteristics of the pseudoarticulation between the enlarged transverse process and sacrum seen in Castellvi 2a LSTV and explore the involvement of nervous tissue in pain generation.MethodsImmunohistochemical analysis using S100 protein staining was performed to assess the presence of nerve tissue.ResultsThese changes included fibrillation, chondrocyte cloning, alterations in the proteoglycan matrix, and focal chondrocyte necrosis. Notably, no nerve tissue was observed in any of the specimens, as confirmed by negative S100 protein staining.ConclusionsThe study findings suggest that nerve tissue is not involved in the nociceptive mechanisms underlying pain in BS. The histologic similarities between the pseudoarticulation and osteoarthritic joints indicate that pseudoarticulation itself may be a significant source of pain in BS. These insights contribute to our understanding of the pathophysiology of BS and support treatment paradigms prioritizing pain control with medications such as NSAIDs before considering surgical intervention. Future studies with larger sample sizes and in vivo models are needed to further validate these findings and explore the changes in joint histology under biomechanical forces in LSTVs.Copyright © 2024. Published by Elsevier Inc.

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