Onyiuke Grading Scale: A Clinical Classification System for the Diagnosis and Management of Bertolotti Syndrome

Abstract

Abstract INTRODUCTION Lumbosacral transitional vertebrae (LSTV) is a common anatomic variant of the spine, characterized by the formation of a pseudoarticulation between the transverse process of the lumbar vertebrae and sacrum or ilium. The altered biomechanics and instability of the spine have been implicated as a potential source of low back pain dubbed Bertolotti Syndrome, named for the Italian physician who initially reported such a rare condition. Traditionally, lumbosacral transitional vertebra have been subdivided into types I-IV based on the Castellvi radiographic classification system.1 However, identifying the type of LSTV in this way fails to consider these findings within the clinical context and provides no clinical relevance to the treatment of Bertolotti Syndrome. METHODS Patients presenting with back pain between 2011 and 2018 attributable to a lumbosacral transitional vertebra were identified retrospectively. Data was collected from these patients' charts regarding demographic information, clinical presentation, diagnostic imaging, treatment, and outcomes. Based on evaluation of these cases and review of the literature, a diagnostic-therapeutic algorithm is proposed. RESULTS Based on our experiences evaluating and treating these patients and review of the existing literature, we propose a clinical classification system for Bertolotti Syndrome, we proposed a 4-grade scale for patients with Bertolotti syndrome based upon location, severity, and characteristics of pain experienced due to LSTVs. CONCLUSION Based on our experience with the cases illustrated here, we recommend managing patients with LSTV based on our diagnostic-therapeutic algorithm. Moving forward, a larger prospective study with a larger patient cohort is needed to further validate the treatment paradigm.