Owing to the scarcity of pathologic evidence, there exists much perplexity as to the origin of the pain accompanying disorders in the lower part of the back, and one wonders whether the old conceptions of the sacrolumbar and sacro-iliac entities are any longer adequate.
In the last two decades certain morphologic factors, principally of the type of anatomic variations, have been variously claimed as producers of pain low in the back, but in most instances no convincing causal connection could be established. For instance, in the question of the long-impinging transverse process and of sacralization, physicians are today far from acknowledging the so-called Bertolotti syndrome (sacralization, sciatica and scoliosis). Although it is a variation of high frequency (17.6 per cent), many doubt its pathogenic significance (Putti,1 Hass2). Zur Verth3 considered resection not justified.
The case of the horizontal sacrum and other architectural deficiencies making for instability of
STEINDLER A, Luck JV. DIFFERENTIAL DIAGNOSIS OF PAIN LOW IN THE BACKALLOCATION OF THE SOURCE OF PAIN BY THE PROCAINE HYDROCHLORIDE METHOD. JAMA. 1938;110(2):106–113. doi:10.1001/jama.1938.02790020020007