Minimally Invasive Microendoscopic Resection of the Transverse Process for Treatment of Low Back Pain with Bertolotti’s Syndrome

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.

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention

“…Twenty patients were diagnosed with a bilateral LSTV [ 11 – 20 ]: 10 patients treated bilaterally 8 patients received steroid injections [ 12 , 13 , 20 ] 1 patient treated with resection of the LSTV on both sides [ 16 ] 1 patient surgically treated with lateral posterior fusion [ 18 ] 10 patients treated unilaterally 5 reported only unilateral LBP [ 13 , 15 , 17 ] 4 showed unilateral bony spurs [ 11 , 18 , 19 ] 1 accepted only treatment in the most symptomatic side of LBP [ 16 ]. …”

“…10 patients treated unilaterally 5 reported only unilateral LBP [ 13 , 15 , 17 ] 4 showed unilateral bony spurs [ 11 , 18 , 19 ] 1 accepted only treatment in the most symptomatic side of LBP [ 16 ]. …”

Percutaneous Full Endoscopic Transverse Processectomy for Bertolotti’s Syndrome

“…And the authors pointed out that the results with posterolateral fusion were only slightly better than those with conservative treatment in a comparable group. Whereas, many authors reported favorable results of technique to simply resect the pseudo-articulation or decompress entrapment of the L5 nerve root [6][7][8]13,[24][25][26] . Some of them reported minimal invasive technique using a tubular retractor and suggested that it was recommended as an effective procedure.…”

“…Current operative techniques for treating BS are normally based on the procedure including decompression of L5 nerve root as well as resection of the pseudo-articulations or the part of TP which contact with ala of sacrum. In recent years, minimally invasive techniques have been reported by a large number of authors [6][7][8][9] . However, there are still only a few reports on percutaneous full endoscopic surgery for BS.…”

Untitled

“…LSTVs include sacralization of the L5 vertebral body and lumbarization of the S1 segment while demonstrating varying morphology, ranging from broadened transverse processes to complete fusion. 5 The most common types of LSTV that present with symptomatic Bertolotti's syndrome are the Castellvi type I and type II; type III and type IV variants rarely present with symptoms referable with confirmatory and provocative testing to the transitional vertebra itself, and therefore there is limited experience and no case reports of treatment toward this particular entity. Case Description We illustrated a case of a 37 years old female in which a computed tomography scan demonstrated type III LSTV on the left and a type I anomaly on the right.…”