Bertolotti's syndrome is described as lower back pain with the presence of lumbosacral transitional vertebrae (LSTV) associated with an articulation, pseudoarticulation, or full fusion of the transverse process to the sacrum and ilium. We present a unique case of the management of a 57-year-old woman with treatment-resistant lower back pain who underwent endoscopic resection of a pseudoarticulation related to LSTV. The patient underwent multiple treatment regimens without achieving satisfactory relief. These included physical therapy, sacroiliac (SI) joint injections, radiofrequency lesioning at multiple levels, and spinal cord stimulator placement. Relief with injection at the patient's pseudoarticulation confirmed this as a contributor to the patient's back pain. Interventional management of Bertolotti's syndrome can include different modalities, most recently including minimally invasive surgical techniques. This patient experienced partial relief of lower back pain after undergoing minimally invasive resection of the pseudoarticulation. This case demonstrates the benefit of a minimally invasive resection of this anatomic abnormality in a patient who has undergone previous treatments. Isolating this anomaly as a source of pain is necessary to ensure a favorable response and prevent needless surgery.