Surgical management of Bertolotti’s syndrome in two adolescents and literature review

Abstract

Background: Bertolotti’s syndrome is defined by back pain and/or radicular symptoms attributed to a congenital lumbosacral transitional vertebra (LSTV). There are few studies that discuss the surgical management of Bertolotti’s syndrome. Here, we report long-term outcomes after resecting a pseudoarthrosis between the sacrum and L5 in two teenage patients, along with a review of literature. Case Descriptions: Surgical resection of a lumbosacral bridging articulation (LSTV type IIa) was performed in two patients, 15 and 16 years of age who presented with intractable back pain. The adequacy of surgery was confirmed with postoperative studies. In both patients, pain and functional status improved within 6 weeks and have remained improved at last follow-up. Conclusion: Surgical removal of a pathologic L5 transverse process fused to the sacral ala in two young patients with Bertolotti’s syndrome improved postoperative pain and increased overall function. Given the progressive nature of Bertolotti’s syndrome, surgical intervention in young patients should be considered to mitigate years of chronic pain and attendant morbidity.

The effectiveness of preoperative assessment using a patient-specific three-dimensional pseudoarticulation model for minimally invasive posterior resection in a patient with Bertolotti’s syndrome: a case report

“…Even recently, several researchers have reported surgical options; however, the appropriate surgical method remains controversial. Although many literatures reported the use and outcome of surgical posterior resection [ 1 , 4 , 5 , 10 ], this is the first report that used a 3D plaster model of LSTV for surgical planning and strategy identification preoperatively. The effectiveness of patient-specific 3D plaster model is to understand the details of LSTV sterically and rehearse the methods.…”

“…Bertolotti’s syndrome is characterized by congenital lumbosacral transitional vertebrae (LSTV) most commonly occurring at L5 level and by enlarged transverse process of L5 articulates or unilateral or bilateral unions with the sacral area [ 1 ]. This syndrome has been reported to result in low back pain in young patients [ 2 ].…”

Lumbalgia por síndrome de Bertolotti

“…Cuando el tratamiento conservador del SB resulta insuficiente, existe la posibilidad de manejo quirúrgico con escisión de la megaapófisis transversa. [1][2][3][4][5][6] Por último, dada la alta prevalencia de estas variantes anatómicas en la población general, el síndrome de Bertolotti debe considerarse en el diagnóstico diferencial de cualquier paciente con lumbalgia con o sin radiculopatía.…”

Pediatric Back Pain Associated with Bertolotti Syndrome

“…Because of this wide prevalence, Quinlan et al recommend providers consider Bertolotti syndrome in the differential for LBP, especially in younger patients 3 . However, to the best of our knowledge, only a few case reports of pediatric patients with Bertolotti syndrome have been described [4][5][6][7][8] .…”

“…Although there is substantial literature on management of Bertolotti syndrome in adults, to the best of our knowledge, there is no consensus on managing this condition in the pediatric population 16 . Previous case reports of pediatric Bertolotti syndrome have focused on either medical treatment through steroid/anesthetic injections or surgical treatment through resection of the overgrown mega-apophysis [4][5][6][7][8] .…”