Dr. James Cox explains an underdiagnosed cause of lower back pain called Bertolotti’s syndrome and how it can be effectively treated with Cox Technic.

Dr. Cox is the developer of Cox® Technic Flexion Distraction Manipulation and the proud participant in the on-going federal research projects involving the National University of Health Sciences, Palmer College of Chiropractic Research Center, Loyola Stritch School of Medicine, University of Illinois, University of Iowa, Auburn University, Keiser University, etc. He is a member of the postgraduate faculty of the National University of Health Sciences and has been privileged to speak throughout the world.

Resources:

About Dr. Cox

curriculum vitae 

link to info on supplements: 

• Cox Technic Resource Center Inc
• Discat Plus Enhanced specifically
• Discat & Joint Pain Relief specifically

Find a Back Doctor

The Cox 8 Table by Haven Medical

References:

Cox JM. Low Back Pain: Mechanism, Diagnosis, Treatment. 7th ed. Lippincott Williams & Wilkins, 2011, Chapter 12, “Transitional Segment.” Pages 578-588

Keim HA, Kirkaldy Willis WH. “Low Back Pain.” CIBA: Clinical Symposia, 1980;32(6).

Crane J, Cragon R, O’Neill J, Berger AA, Kassem H, Sherman WF, Paladini A, Varrassi G, Odisho AS, Miriyala S, Kaye AD. A Comprehensive Update of the Treatment and Management of Bertolotti’s Syndrome: A Best Practices Review. Orthop Rev (Pavia). 2021 Jun 22;13(2):24980. doi: 10.52965/001c.24980. PMID: 34745474; PMCID: PMC8567758.

Jin L, Yin Y, Chen W, Zhang R, Guo J, Tao S, Guo Z, Hou Z, Zhang Y. Role of the Lumbosacral Transition Vertebra and Vertebral Lamina in the Pathogenesis of Lumbar Disc Herniation. Orthop Surg. 2021 Dec;13(8):2355-2362. doi: 10.1111/os.13122. Epub 2021 Nov 17. PMID: 34791784.

Vadera S: Castellvi classification of lumbosacral transitional vertebrae. https://radiopaedia.org/articles/castellvi-classification-of-lumbosacral-transitional-vertebrae. Sourced on 12/11/21

Kawtharani S, Bsat SA, El Housheimy M, Moussalem C, Halaoui A, Sunna T. A case of Bertolotti’s syndrome as a cause of sciatica. Surg Neurol Int. 2021 Oct 11;12:516. doi: 10.25259/SNI_756_2021. PMID: 34754566; PMCID: PMC8571205.

Hanhivaara J, Määttä JH, Karppinen J, Niinimäki J, Nevalainen MT. The Association of Lumbosacral Transitional Vertebrae with Low Back Pain and Lumbar Degenerative Findings in MRI: A Large Cohort Study. Spine (Phila Pa 1976). 2022 Jan 15;47(2):153-162. doi: 10.1097/BRS.0000000000004244. PMID: 34610612.

Sun J, Chhabra A, Thakur U, Vazquez L, Xi Y, Wells J. The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome : a cross-sectional evaluation of a prospective hip registry cohort. Bone Joint J. 2021 Aug;103-B(8):1351-1357. doi: 10.1302/0301-620X.103B8.BJJ-2020-2481.R1. PMID: 34334048.

Watanabe K, Mitsui K, Sasaki J, Kumaki D. Subacute hemorrhagic cyst of the ligamentum flavum occurred in the lumbosacral transitional vertebra presenting as progressive lumbar nerve root compression: a case report. J Spine Surg. 2021 Jun;7(2):238-243. doi: 10.21037/jss-20-683. PMID: 34296039; PMCID: PMC8261570.

Tatara Y, Niimura T, Sekiya T, Mihara H. Changes in Lumbosacral Anatomy and Vertebral Numbering in Patients with Thoracolumbar and/or Lumbosacral Transitional Vertebrae. JB JS Open Access. 2021 Jul 14;6(3):e20.00167. doi: 10.2106/JBJS.OA.20.00167. PMID: 34278183; PMCID: PMC8280013.

Sugiura K, Morimoto M, Higashino K, Takeuchi M, Manabe A, Takao S, Maeda T, Sairyo K. Transitional vertebrae and numerical variants of the spine : prevalence and relationship to low back pain or degenerative spondylolisthesis. Bone Joint J. 2021 Jul;103-B(7):1301-1308. doi: 10.1302/0301-620X.103B7.BJJ-2020-1760.R1. PMID: 34192932.

Gluding D, Stock KF, Tellhelm B, Kramer M, Eley N. Genetic background of lumbosacral transitional vertebrae in German shepherd dogs. J Small Anim Pract. 2021 Nov;62(11):967-972. doi: 10.1111/jsap.13380. Epub 2021 Jun 21. PMID: 34155659.

Okamoto M, Hasegawa K, Hatsushikano S, Kobayashi K, Sakamoto M, Ohashi M, Watanabe K. Influence of lumbosacral transitional vertebrae on spinopelvic parameters using biplanar slot scanning full body stereoradiography-analysis of 291 healthy volunteers. J Orthop Sci. 2021 May 6:S0949-2658(21)00126-3. doi: 10.1016/j.jos.2021.03.009. Epub ahead of print. PMID: 33966957.

Garg B, Mehta N, Goyal A, Rangaswamy N, Upadhayay A. Variations in the Number of Thoracic and Lumbar Vertebrae in Patients With Adolescent Idiopathic Scoliosis: A Retrospective, Observational Study. Int J Spine Surg. 2021 Apr;15(2):359-367. doi: 10.14444/8047. Epub 2021 Apr 1. PMID: 33900995; PMCID: PMC8059404.

Shinonara K, Kaneko M, Ugawa R, Arataki S, Takeuchi K. The effectiveness of preoperative assessment using a patient-specific three-dimensional pseudoarticulation model for minimally invasive posterior resection in a patient with Bertolotti’s syndrome: a case report. J Med Case Rep. 2021 Feb 16;15(1):68. doi: 10.1186/s13256-020-02635-y. PMID: 33588921; PMCID: PMC7885622.

Becker L, Ziegeler K, Diekhoff T, Palmowski Y, Pumberger M, Schömig F. Musculature adaption in patients with lumbosacral transitional vertebrae: a matched-pair analysis of 46 patients. Skeletal Radiol. 2021 Aug;50(8):1697-1704. doi: 10.1007/s00256-021-03722-x. Epub 2021 Feb 3. PMID: 33533964; PMCID: PMC8208907.

Haffer H, Becker L, Putzier M, Wiethölter M, Ziegeler K, Diekhoff T, Pumberger M, Hardt S. Changes of Fixed Anatomical Spinopelvic Parameter in Patients with Lumbosacral Transitional Vertebrae: A Matched Pair Analysis. Diagnostics (Basel). 2021 Jan 2;11(1):59. doi: 10.3390/diagnostics11010059. PMID: 33401698; PMCID: PMC7824527.

Luo R, Barsoum D, Ashraf H, Cheng J, Hurwitz NR, Goldsmith CY, Moley PJ. Prevalence of Lumbosacral Transitional Vertebrae in Patients With Symptomatic Femoroacetabular Impingement Requiring Hip Arthroscopy. Arthroscopy. 2021 Jan;37(1):149-155. doi: 10.1016/j.arthro.2020.08.034. Epub 2020 Sep 10. PMID: 32919025; PMCID: PMC8177691.

Johnson ZD, Aoun SG, Ban VS, El Ahmadieh TY, Kafka B, Wolfe C, Adogwa O, Bagley CA, Tamimi MA. Bertolotti Syndrome With Articulated L5 Transverse Process Causing Intractable Back Pain: Surgical Video Showcasing a Minimally Invasive Approach for Disconnection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2021 Feb 16;20(3):E219-E220. doi: 10.1093/ons/opaa343. PMID: 33294931.

Dhanjani S, Altaleb M, Margalit A, Puvanesarajah V, Jain A. Pediatric Back Pain Associated with Bertolotti Syndrome: A Report of 3 Cases with Varying Treatment Strategies. JBJS Case Connect. 2021 Nov 17;11(4). doi: 10.2106/JBJS.CC.21.00068. PMID: 34788257.