BACKGROUND: Bertolotti’s syndrome (BS) is an underrecognized cause of chronic low back pain, arising from a lumbosacral transitional vertebra with pseudoarticulation to the sacrum or ilium. Conservative management often fails, and surgical resection is typically considered. Radiofrequency ablation (RFA) is well established for facetogenic pain, but literature on bipolar RFA for BS is scarce.

CASE REPORT: We present 2 patients with symptomatic BS who failed conservative therapies but experienced significant relief after bipolar RFA of the pseudoarticulation. Patient A achieved 80% pain relief, maintained at 7 months postprocedure. Patient B reported substantial initial improvement that persisted at 50% for 2 months before surgical referral. Both underwent fluoroscopically guided bipolar RFA targeting the pseudoarticulation.

CONCLUSIONS: Bipolar RFA may be a promising minimally invasive option for BS, offering broader, more continuous lesions suited for irregular joint anatomy. Further studies are warranted to confirm its efficacy and long-term outcomes.

KEYWORDS: Bertolotti, back pain, bipolar radiofrequency ablation, pseudojoint, radiofrequency ablation