Bertolotti's Syndrome Research Articles

Bertolotti's syndromeの治療成績

Bertolotti's syndromeの治療成績

Transitional lumbosacral vertebrae and low back pain: diagnostic pitfalls and management of Bertolotti's syndrome

Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.

Bertolotti's Syndrome: A Case Report

A case report and literature review is presented. To review relevant data for the management of Bertolotti's syndrome and to determine whether the transverse process-ilium articulation may be a pain generator. Bertolotti's syndrome is associated with axial low back pain secondary to arthritic changes; the pain generator in the disorder is unclear. We present a case report of symptomatic Bertolotti's syndrome managed with intra-articular steroid injections. A patient with Bertolotti's syndrome had significant relief of axial pain after steroid injection of the ilium-transverse process articulation. Steroid therapy may be a non-surgical alternative for the treatment of symptomatic Bertolotti's syndrome.

Lumbosacral transitional vertebra causing Bertolotti's syndrome: a case report and review of the literature

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.

MINIMALLY INVASIVE SURGICAL TREATMENT OF BERTOLOTTI'S SYNDROME

This article aims to provide more insight into the presentation, diagnosis, and treatment of Bertolotti's syndrome, which is a rare spinal disorder that is very difficult to recognize and diagnose correctly. The syndrome was first described by Bertolotti in 1917 and affects approximately 4 to 8% of the population. It is characterized by an enlarged transverse process at the most caudal lumbar vertebra with a pseudoarticulation of the transverse process and the sacral ala. It tends to present with low back pain and may be confused with facet and sacroiliac joint disease. In this case report, we describe a 40-year-old man who presented with low back pain and was eventually diagnosed with Bertolotti's syndrome. The correct diagnosis was made based on imaging studies which included computed tomographic scans, plain x-rays, and magnetic resonance imaging scans. The patient experienced temporary relief when the abnormal pseudoarticulation was injected with a cocktail consisting of lidocaine and steroids. In order to minimize the trauma associated with surgical treatment, a minimally invasive approach was chosen to resect the anomalous transverse process with the accompanying pseudoarticulation. The patient did well postoperatively and had 97% resolution of his pain at 6 months after surgery. As with conventional surgical approaches, a complete knowledge of anatomy is required for minimally invasive spine surgery. This case is an example of the expanding utility of minimally invasive approaches in treating spinal disorders.

Surgical treatment of Bertolotti's syndrome. Follow-up of 16 patients.

We surgically treated 16 patients with Bertolotti's syndrome (chronic, persistent low back pain and radiographically diagnosed transitional lumbar vertebra). Eight had posterolateral fusion and another eight resection of the transitional articulation. Thirteen patients had in addition to the chronic low back pain, suffered from repeated episodes or chronic sciatica. In six cases with resection treatment, local injections were administered at the transitional articulation before deciding for resection of the transitional joint; each patient reported transient relief of pain, while this preoperative test did not correlate with successful outcome of treatment. Six patients had to be treated with second operations. Ten of the 16 operatively treated patients showed improvement of the low back pain, and this result was similar in the group treated with fusion and in that treated with resection. Seven had no low back pain at follow-up, and the improvement according to the Oswestry pain scale was similar in the two groups, and statistically significant. Eleven patients still had persisting episodes of sciatica (versus 13 preoperatively). The average disability according to the Oswestry total disability scale was 30%, corresponding with moderate outcome, and both operatively treated groups did equally well. At follow-up the first disc above the fused segments was found to be degenerated in seven out of eight cases, and in the group treated with resection the first disc above the transitional vertebra was degenerated in five cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Bertolottiʼs Syndrome Revisited

Bertolotti's syndrome refers to the association of back pain with lumbosacral transitional vertebrae. Such vertebrae were observed in 140 of 2,000 adults with back pain over a 4-year period of study. Each patient had radiographic evaluation of the lumbar spine by plain films as well as a sectional imaging modality (magnetic resonance [MR] or computed tomography [CT]). The overall incidence of structural pathology (eg, spinal stenosis and disc protrusion) detected by CT or MR was not apparently higher in patients with transitional vertebrae, but the distribution of these lesions was significantly different. Disc bulge or herniation, when it occurred, was nearly nine times more common at the interspace immediately above the transitional vertebra than at any other level. Spinal stenosis and nerve root canal stenosis were more common at or near the interspace above the transitional vertebra than at any other level. Degenerative change at the articulation between the transverse process of the transitional vertebra and the pelvis was an uncommon occurrence; when seen there was no significant correlation with the reported side of pain. It is postulated that hypermobility and altered stresses become concentrated in the spine at the level immediately above a lumbar transitional vertebra. Accelerated disc and facet joint degeneration at this level may then result.

DIFFERENTIAL DIAGNOSIS OF PAIN LOW IN THE BACK

Owing to the scarcity of pathologic evidence, there exists much perplexity as to the origin of the pain accompanying disorders in the lower part of the back, and one wonders whether the old conceptions of the sacrolumbar and sacro-iliac entities are any longer adequate. In the last two decades certain morphologic factors, principally of the type of anatomic variations, have been variously claimed as producers of pain low in the back, but in most instances no convincing causal connection could be established. For instance, in the question of the long-impinging transverse process and of sacralization, physicians are today far from acknowledging the so-called Bertolotti syndrome (sacralization, sciatica and scoliosis). Although it is a variation of high frequency (17.6 per cent), many doubt its pathogenic significance (Putti,1Hass2). Zur Verth3considered resection not justified. The case of the horizontal sacrum and other architectural deficiencies making for instability of

On the Incidence of the Sacralized Transverse Process and Its Significance

INTEREST in the sacralization of the transverse process of the fifth lumbar vertebra has manifested itself in a very extensive list of publications, the greater part being by French and Italian writers. It is evident that the problem of the sacralized transverse process has, in France, attracted a degree of attention seemingly out of proportion to its medical importance. One writer, Leri (1), caustically states that it has become the “mode,” which is reminiscent of our “sacro-iliac strain” of a few years ago. Painful sacralization has been designated “Bertolotti's syndrome” in Italy, following the publications on that subject of the writer of that name (2). In England, Holland (3) has published an excellent paper on this subject and states that there were no other British titles. Among other things, he reports that he encountered 10 cases in the course of a year. In this country, Goldthwait (4) and Adams (5) have written on sacralization. Moore (6), Bauman (7) and Rugh (8) have dealt with the operative re...