Transitional Vertebra and Spina Bifida Occulta Related with Chronic Low Back Pain in a Young Patient

Maryam Kundi,Sumbal Babar,Maham Habib,Salman Assad,Asif K Kundi,Amjad Sheikh

doi:10.7759/cureus.837

Abstract

Bertolotti’s syndrome (BS) must be considered as a differential diagnosis in a young patient presenting with low back pain (LBP). We present a case of a 26-year-old male complaining of mild chronic LBP for six years, radiating to his left thigh for the past six months. He has been taking non-steroidal anti-inflammatory drugs (NSAIDs) with skeletal muscle relaxants for pain relief. The X-ray and computed tomography (CT) imagings showed congenital enlargement of the left transverse process of the fifth lumbar (L5) vertebra forming pseudo-articulation with the sacrum and unilateral pars interarticularis defect at the L4 level on the left side, respectively. He has managed with gabapentin 100 mg three times a day for his neuropathic left leg pain. On follow-up, the patient reported that his pain has improved with gabapentin and it decreased from 8/10 to 4/10 on the visual analogue scale.

Highlights

Bertolotti's syndrome (BS) is described by the presence of a variation of the fifth lumbar (L5) vertebra with a large transverse process which is combined or articulated with either iliac crest or sacral basis leading to chronic persistent back pain [1]
Lumbar sacral transitional vertebrae (LSTV) are congenital spinal anomalies defined as either sacralisation of the lowest lumbar segment or lumbarisation of a most superior sacral segment of the spine
We report a case of a young patient with chronic low back pain radiating to his left thigh along the distribution of L4 dermatome

Summary

Introduction

Bertolotti's syndrome (BS) is described by the presence of a variation of the fifth lumbar (L5) vertebra with a large transverse process which is combined or articulated with either iliac crest or sacral basis leading to chronic persistent back pain [1]. We report a case of a young patient with chronic low back pain radiating to his left thigh along the distribution of L4 dermatome. How to cite this article Kundi M, Habib M, Babar S, et al (October 19, 2016) Transitional Vertebra and Spina Bifida Occulta Related with Chronic Low Back Pain in a Young Patient. On follow-up, the patient reported that his pain has improved with gabapentin and it has decreased from 8/10 to 4/10 on a visual analogue scale In the past, he has been hospitalized multiple times for lumbago, colitis, urinary tract infection (UTI), and depressive disorder. He has been hospitalized multiple times for lumbago, colitis, urinary tract infection (UTI), and depressive disorder He was previously advised physical therapy for LBP but he went against medical advice and opted not to undergo physical therapy. There was a unilateral pars interarticularis defect at the L4 level on the left side (Figure 2)

Discussion

Conclusions

Findings

Disclosures