Bertolotti Syndrome in Children

About one in ten Australians who have lumbar X-rays has a lumbosacral transitional vertebra. The anatomy is present at birth: the lumbosacral border is set in the embryo by genes that have been studied for thirty years, the trait is heritable in animals, three human loci have been identified, and it runs in families without following a rule. In children it is silent in early life, tethers the growing spine, and in a minority becomes painful from the teens onwards, when it is called growing pains, muscular strain or posture and treated for years as non-specific.This guide sets out, for general practitioners, paediatricians, sports physicians, radiologists, pain physicians and paediatric spine surgeons, what is inherited and what is not; how often the anatomy is present in children and what it does to a growing spine; how the seventeen reported children presented; assessment and imaging in an Australian general practice, including the Medicare MRI item a general practitioner may use for a patient under 16; what the reported cases show about treatment; the referral pathway; and what to tell a family, including the parent who has the condition and asks about the child. Two further chapters set out what patients report about their childhoods and what each companion guide will provide, and an appendix gives a consultation checklist.Every clinical statement is referenced to the published evidence, and the notes at the end say what could and could not be verified.