Clinical assessment and management of Bertolotti Syndrome: a review of the literature

McGrath, Kyle; Schmidt, E; Rabah, Nicholas M.; Abubakr, Mohammad; Steinmetz, Michael P.

doi:10.1016/j.spinee.2021.02.023

Cited by 38 publications

(30 citation statements)

References 62 publications

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“…The diagnosis is often missed on X-rays alone, and may even not be recognized on either MRI or CT scans. [ 3 ] Bertolotti’s syndrome showed to encounter longer work up and received more epidural steroid injections whereby they were found out to have worse physical and mental health scores. [ 1 ] Notably, recognizing this anatomic variant becomes particularly important in patients complaining of sciatica without disc herniations or other clear pathology on MRI/CT studies.…”

Section: Discussionmentioning

confidence: 99%

A case of Bertolotti’s syndrome as a cause of sciatica

Kawtharani¹,

Bsat²,

Housheimy³

et al. 2021

Surgical Neurology International

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Background: Bertolotti’s syndrome (i.e., varying extent of fusion between the last lumbar vertebra and the first sacral segment) or lumbosacral transitional vertebrae is a rare cause of back pain. Notably, this syndrome is one of the differential diagnoses for patients with refractory back pain/sciatica. Case Description: A 71-year-old male presented with low back pain of 3 years duration that radiated into the right lower extremity resulting in numbness in the L5 distribution. He then underwent a minimally invasive approach to resect the L5 “wide” transverse process following the CT diagnosis of Bertolotti’s syndrome. Prior to surgery, patient reported pain that was exacerbated by ambulation that resolved post-operative. Conclusion: Bertolotti’s syndrome is one of the rare causes of sciatica that often goes undiagnosed. Nevertheless, it should be ruled out for patients with back pain without disc herniations or other focal pathology diagnosed on lumbar MR scans.

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Section: Discussionmentioning

confidence: 99%

A case of Bertolotti’s syndrome as a cause of sciatica

Kawtharani¹,

Bsat²,

Housheimy³

et al. 2021

Surgical Neurology International

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“…Ведущим методом объективной диагностики люмбализации позвонка S I служит лучевое исследование позвоночника и крестца [1]. В ходе обследования пациентов используют как обзорную рентгенографию [22,44], так и компьютерную [45,46] и магнитно-резонансную [47,48] томографию. Эти методы лучевой диагностики применяют как в изолированном виде, так и комплексно, с целью выбора подхода к планируемой терапии, в том числе для вынесения показаний к хирургическому лечению [49].…”

Section: объективная диагностикаunclassified

Transitional lumbosacral vertebrae

Скрябин

2023

Kazan Med J

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Transitional lumbosacral vertebrae in the form of SI lumbarization and LV sacralization are classified as spinal anomalies. In the domestic medical literature, there are few publications devoted to these pathological conditions. In the course of a study of the available literature on the problem of transitional lumbosacral vertebrae, it was found that the frequency of cases of transitional lumbosacral vertebrae diagnosis ranges from 4 to 30% of clinical cases. The share of patients with lumbar vertebrae accounts for an average of 40% of cases, the share of patients with sacralization of the vertebrae is 60% of clinical observations. Mutations in the Hox gene are considered to be the trigger for the development of pathology, and pain is usually the leading clinical symptom. Plain radiography, computed tomography and magnetic resonance imaging are used to diagnose the pathology. Radiation imaging of the entire spine is required to eliminate errors in vertebrae counting. The type of pathology is determined using various classifications. As conservative therapeutic agents, drug blockades applying anesthetics and hormonal drugs are used. The arsenal of surgical interventions includes resection of the enlarged transverse process of the supracacral vertebra, decompression of stenotic intervertebral foramina, impulsive radiofrequency ablation, and posterior fusion. Measures for the prevention of pathology are not currently developed.

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“…LSTV are classified according to Castellvi, assessing the enlargement and fusion of the processus transversus with the sacral ala [ 5 ]. The association between LSTV and back pain was first reported by Bertolotti probably caused by a pseudarthrosis between the widened processus transversus and the sacral bone and a consecutive irritation at the contact area [ 6 ]. In addition, extraspinal nerve compression through the widened processus transversus has been described [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…A reduced mobility between the transitional vertebra and the sacrum could be preserved by the formation of either an articulation or by bony union between the vertebra and the sacrum through its transverse process [ 10 ]. Furthermore, a reduced mobility of the transitional segment is discussed and attributed to an increased osseous connectivity of the transversal process of the LSTV with the sacral ala with a compensatory hypermobility of the cranially adjacent segment [ 6 , 13 ]. The results are mainly based on in vitro analyses, whose used protocols have never been validated against in vivo kinematic data.…”

Section: Introductionmentioning

confidence: 99%

“…An increased degeneration of the cranially adjacent segment to the LSTV is also suspected to be a reason for back pain in patients with LSTV. There is a consensus in the literature regarding increased disc degeneration [8][9][10][11][12] and a higher incidence of facet joint degeneration and neuroforaminal stenosis in the cranial segment adjacent to LSTV [11,12] may be caused by an altered load transfer [6,10,13]. A possible instability of the vertebral segment above the transitional vertebra caused by a weak iliolumbar ligament could lead to subsequent disc degeneration.…”

Section: Introductionmentioning

confidence: 99%

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Lumbosacral transitional vertebrae alter the distribution of lumbar mobility–Preliminary results of a radiographic evaluation

et al. 2022

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Background Lumbo-sacral transitional vertebrae (LSTV) are one of the most common congenital variances of the spine. They are associated with an increased frequency of degeneration in the cranial adjacent segment. Hypermobility and concomitant increased loads are discussed as a possible reason for segmental degeneration. We therefore examined the lumbar and segmental motion distribution in patients with LSTV with flexion-extension radiographs. Methods A retrospective study of 51 patients with osteochondrosis L5/S1 with flexion and extension radiographs was performed. Of these, 17 patients had LSTV and were matched 1:1 for age and sex with patients without LSTV out of the collective of the remaining 34 patients. The lumbar and segmental range of motion (RoM) by segmental lordosis angle and the segmental wedge angle were determined. Normal distribution of parameters was observed by Kolmogorov-Smirnov-test. Parametric data were compared by paired T-test. Non-parametric data were compared by Wilcoxon-rank-sum-test. Correlations were observed using Spearman’s Rank correlation coefficient. A p-value <0.05 was stated as statistically significant. Results Patients with LSTV had mean age of 52.2±10.9, control group of 48.9±10.3. Both groups included 7 females and 10 males. Patients with LSTV presented with reduced RoM of the lumbar spine (LSTV 37.3°±19.2°, control 52.1°±20.5°, p = 0.065), however effects were statistically insignificant. LSTV significantly decreased segmental RoM in the transitional segment (LSTV 1.8°±2.7°, control 6.7°±6.0°, p = 0.003). Lumbar motion distribution differed significantly; while RoM was decreased in the transitional segment, (LSTV 5.7%, control 16.2%, p = 0.002), the distribution of lumbar motion to the cranial adjacent segment was increased (LSTV 30.7%, control 21.6%, p = 0.007). Conclusion Patients with LSTV show a reduced RoM in the transitional segment and a significantly increased motion distribution to the cranial adjacent segment in flexion-extension radiographs. The increased proportion of mobility in the cranial adjacent segment possibly explain the higher rates of degeneration within the segment.

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Clinical assessment and management of Bertolotti Syndrome: a review of the literature

Cited by 38 publications

References 62 publications

A case of Bertolotti’s syndrome as a cause of sciatica

A case of Bertolotti’s syndrome as a cause of sciatica

Transitional lumbosacral vertebrae

Lumbosacral transitional vertebrae alter the distribution of lumbar mobility–Preliminary results of a radiographic evaluation

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