Abstract
Bertolotti's syndrome is characterized by anomalous enlargement of the transverse process of the most caudal lumbar segment, causing chronic and persistent low back pain or sciatica. We describe the case of a 45-year-old woman who presented with left sciatic pain and low back pain due to a recurrent lumbar disc herniation at L4-5 with Bertolotti's syndrome. Selective L5 nerve root block and local injection of lidocaine into the articulation between the transverse process and sacral ala temporarily relieved the left sciatic pain and low back pain, respectively. To confirm the effect of local injection on low back pain, we gave a second local injection, which once again relieved the low back pain. Microendoscopic resection of the pseudoarticulation region and discectomy successfully relieved all symptoms. This report illustrates the effectiveness of minimally invasive resection of the transverse process for the treatment of low back pain with Bertolotti's syndrome.
Highlights
Bertolotti’s syndrome, first reported in 1917, is characterized by anomalous enlargement of the transverse process of the most caudal lumbar vertebrae with a lumbosacral transitional vertebra (LSTV) described as “sacral assimilation of the lumbar vertebrae.” The enlarged transverse process sometimes fuses or articulates unilaterally or bilaterally with the sacral ala or iliac crest
We present a case of recurrent herniated nucleus pulposus (HNP) at L4-5 with Bertolotti’s syndrome treated by microendoscopic discectomy and resection of the transverse process
Radiculography of the left L5 nerve root showed impingement at the lateral recess
Summary
Bertolotti’s syndrome, first reported in 1917, is characterized by anomalous enlargement of the transverse process of the most caudal lumbar vertebrae with a lumbosacral transitional vertebra (LSTV) described as “sacral assimilation of the lumbar vertebrae.” The enlarged transverse process sometimes fuses or articulates unilaterally or bilaterally with the sacral ala or iliac crest. Bertolotti’s syndrome, first reported in 1917, is characterized by anomalous enlargement of the transverse process of the most caudal lumbar vertebrae with a lumbosacral transitional vertebra (LSTV) described as “sacral assimilation of the lumbar vertebrae.”. The enlarged transverse process sometimes fuses or articulates unilaterally or bilaterally with the sacral ala or iliac crest. The cause of low back pain with Bertolotti’s syndrome remains controversial, and various treatments such as local injection of anesthetic and/or steroid, radiofrequency coagulation, surgical resection, and spinal fusion have been reported [1,2,3,4,5,6,7,8]. We present a case of recurrent herniated nucleus pulposus (HNP) at L4-5 with Bertolotti’s syndrome treated by microendoscopic discectomy and resection of the transverse process
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