Radiographic appearances in lumbar disc prolapse

Maclean, J. G. B.; Tucker, J.K.; J, Latham

doi:10.1302/0301-620x.72b5.2145286

Cited by 10 publications

(6 citation statements)

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“…of them, we selected only studies written in english regarding diagnosis and treatment of Bertolotti's syndrome, which resulted in 18 articles revised 1,2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] .…”

Section: Resultsmentioning

confidence: 99%

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

Almeida

Mattei

Sória

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: 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. Method: We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. Results: 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. Conclusion: 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.Key WorDs: low back pain, lumbosacral region, spine.dor lombar associada à vértebra de transição lombossacra: dificuldades no diagnóstico e manejo da síndrome de bertolotti resumo -Objetivo: A síndrome de Bertolotti é uma desordem congênita da coluna vertebral caracterizada pela ocorrência de uma mega-apófise transversa lombar em uma vértebra de aspecto transicional, que geralmente se articula com o sacro ou com o osso ilíaco. Tal síndrome tem sido considerada possível causa de dor lombar. Método: Análise dos casos de síndrome de Bertolotti que apresentavam dor lombar sem melhora com tratamento conservador e revisão dos artigos publicados. Resultados: Foram revisados cinco pacientes que não apresentaram melhora com o tratamento clínico, sendo que dois foram submetidos à ressecção cirúrgica da mega-apófise transversa. Considerando a experiência adquirida com estes casos, os autores propõem um algoritmo para diagnóstico e tratamento da síndrome de Bertolotti. Conclusão: Ainda não há consenso sobre qual é a terapia mais apropriada para a síndrome de Bertolotti. em pacientes em que a mega-apófise parece ser a origem da lombalgia, a ressecção cirúrgica parece ser um procedimento seguro e efetivo.PAlAvrAs-ChAve: dor lombar, região lombossacral, coluna vertebral.

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Section: Resultsmentioning

confidence: 99%

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

Almeida

Mattei

Sória

et al. 2009

Arq. Neuro-Psiquiatr.

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“…This phenomenon may be due to a relative hypermobility and stress at the segment above the LSTV, and shows analogous features to advanced disc degeneration adjacent to block vertebrae or interbody fusion 3 5 27 37 41. On the other hand, due to restricted bending and rotational movements, LSTV seems to protect the segment below the LSTV from disc degeneration 5 16 19 26 37 40. In any case, the region around LSTV is a common region of pain and thus a common target of different therapeutic modalities.…”

Section: Introductionmentioning

confidence: 98%

“…The clinical significance of LSTV is controversial with no consensus as to their relationship to pain or degenerative disc disease 4 11 13 14 19. Several authors have ascribed low back pain to LSTV,20–23 but the association between low back pain and LSTV has been a matter of debate3–5 9 15 16 21 23–39 since it was first described 20.…”

Section: Introductionmentioning

confidence: 99%

Segmental innervation in lumbosacral transitional vertebrae (LSTV): a comparative clinical and intraoperative EMG study

Hinterdorfer

Parsaei²,

Stieglbauer³

et al. 2010

Journal of Neurology, Neurosurgery & Psychiatry

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“…7,22,31 Some authors have denied any association between LSTV and low-back pain. 18 Limited understanding of the pathophysiology of Bertolotti's syndrome has led to a lack of uniformity in the diagnosis and treatment of patients with this condition. 8,16 Initial treatment of Bertolotti's syndrome typically includes pain management and physical therapy.…”

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confidence: 99%

Minimally invasive tubular resection of the anomalous transverse process in patients with Bertolotti's syndrome

Lubelski

Abdullah

et al. 2014

SPI

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Object Bertolotti's syndrome consists of low-back pain caused by lumbosacral transitional vertebrae (LSTVs) and LSTV-associated biomechanical spinal changes. There is a lack of consensus regarding the cause, clinical significance, and treatment of this condition. The authors aim to characterize the clinical presentation of patients with Bertolotti's syndrome and describe a minimally invasive surgical treatment for this condition. Methods Seven patients who underwent minimally invasive paramedian tubular-based resection of the LSTV for Bertolotti's syndrome were identified over the course of 5 years. Diagnosis was based on patient history of chronic low-back pain, radiographic findings of LSTV, and pain relief on trigger-site injection with steroid and/or anesthetics. Electronic medical records were reviewed to identify demographics, operative data, and outcomes. Results All patients presented with severe, chronic low-back pain lasting an average of 8 years that was resistant to nonoperative care. At presentation, 6 (86%) of 7 patients experienced radicular pain that was ipsilateral to the LSTV. Radiographic evidence showed a presence of LSTV in all patients on the left (43%), right (29%), or bilaterally (29%). Degenerative disc changes at the L4–5 level immediately above the anomalous LSTV were observed in 6 of 7 (86%) patients; these changes were not seen at the level below the LSTV. Following pseudo-joint injection, all patients experienced temporary relief of their symptoms. All patients underwent a minimally invasive, paramedian tubular-based approach for resection of the LSTV. Three (43%) of 7 patients reported complete resolution of low-back pain, 2 (29%) of 7 patients had reduced low-back pain, and 2 patients (29%) experienced initial relief but return of low-back pain at 1 and 4 years postoperatively. Three (50%) of the 6 patients with radicular pain had complete relief of this symptom. The median follow-up time was 12 months. No intraoperative complication was reported. Two (29%) of 7 patients developed postoperative complications including one with a wound hematoma and another with new L-5 radiculopathy that resolved 2 years after surgery. Conclusions Diagnosis of Bertolotti's syndrome should be considered with adequate patient history, imaging studies, and diagnostic injections. A minimally invasive surgical approach for resection of the LSTV is presented here for symptomatic treatment of select patients with Bertolotti's syndrome whose conditions are refractory to conventional therapy and who have pain that can be attributed to the LSTV. Several short-term complications were noted with this procedure, but overall this procedure is effective for treating symptoms related to Bertolotti's syndrome.

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Radiographic appearances in lumbar disc prolapse

Cited by 10 publications

References 0 publications

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

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

Segmental innervation in lumbosacral transitional vertebrae (LSTV): a comparative clinical and intraoperative EMG study

Minimally invasive tubular resection of the anomalous transverse process in patients with Bertolotti's syndrome

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