Abstract
IntroductionLumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium. The association of that variant with low back pain and the change in the biomechanical properties of the lumbar spine is called Bertolotti’s syndrome.Case presentationWe report a case of a 40-year-old male patient with chronic low back pain extending to the left buttock, just above the ipsilateral sacroiliac joint. Radiographic investigation revealed an anomalous enlargement of the left transverse process of the fifth lumbar vertebra forming a pseudarthrosis with the infrajacent ala of the sacrum.ConclusionIn young patients with back pain the possibility of Bertolotti’s syndrome should always be taken in account.
Highlights
Introduction: Lumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium
Case presentation: We report a case of a 40-year-old male patient with chronic low back pain extending to the left buttock, just above the ipsilateral sacroiliac joint
It has been reported that there is no difference in the prevalence of spondylolysis or spondylolisthesis between patients with transitional vertebra and group controls [12], and that there is no relationship between lumbosacral transitional vertebra and a congenitally narrower canal [4]
Summary
According to Castellvi’s classification, there are four types of lumbosacral transitional vertebrae, type I, dysplastic transverse process with height > 90 mm, type II, incomplete lumbarisation/sacralisation, type III, complete lumbarisation/sacralisation with complete fusion with the neighboring sacral basis and type IV, mixed [2]. Otani et al supported that the transitional vertebra does not influence the incidence of nerve root symptoms They claimed that this vertebra in patients with disc herniation or lumbar canal stenosis without spondylolisthesis may be a risk factor for the development of nerve root symptoms [10]. Quinlan et al found the total incidence of Bertolotti’s syndrome being 4.6%, while the frequency was 11.4% in under 30-year age group These authors claimed that the transitional vertebra should be kept in mind when low back pain is appeared in young individuals [6]. In our case we consider that the localized pain was caused by the degenerative changes of the anomalous articulation between the transverse process of the transitional vertebra and the ala sacrum. The same authors suggested posterolateral fusion if the transitional disc appears to be pathological and the suprajacent disc remains intact [1]
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