- Geisel School of Medicine at Dartmouth, Hanover,
- Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
David F. Bauer
Geisel School of Medicine at Dartmouth, Hanover,
Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
DOI:10.25259/SNI-305-2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Christopher E. Louie, Jennifer Hong, David F. Bauer. Surgical management of Bertolotti’s syndrome in two adolescents and literature review. 05-Jul-2019;10:135
How to cite this URL: Christopher E. Louie, Jennifer Hong, David F. Bauer. Surgical management of Bertolotti’s syndrome in two adolescents and literature review. 05-Jul-2019;10:135. Available from: http://surgicalneurologyint.com/surgicalint-articles/9460/
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.
Keywords: Bertolotti’s syndrome, Lumbosacral transitional vertebrae, Sacralized pseudoarthrosis
Bertolotti’s syndrome is defined as a congenital lumbosacral transitional vertebra (LSTV) that is responsible for disabling low back pain. It most commonly occurs at the L5 level, followed by the L6 level, and is characterized by various morphologic presentations [
A 14-year-old female with midline low back pain and the right hip/leg pain was treated for 9 months with physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) without relief. Her neurological examination was normal. Lumbar X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) studies showed Bertolotti’s syndrome, characterized by a right-sided partially sacralized L5 vertebra with pseudoarthrosis between L5 to S1 and ileum, with areas of irregularity/sclerosis [
A 16-year-old female presented with 2 years of low back pain and 3 months of pain radiating into her left hip refractory to NSAIDs and physical therapy. Comorbidities included recurrent migraines, major depressive disorder, obstructive sleep apnea, and restless leg syndrome. Her neurological examination was normal. The lumbar CT and MRI studies showed Bertolotti’s syndrome on the left at the L5-S1 level characterized by an enlarged left L5 transverse process fused with the ilium and sacrum, with mild degeneration/sclerosis of the left L5 pars interarticularis [
Diagnosis and pathophysiology of Bertolotti’s syndrome
Bertolotti’s syndrome is found in 10% of patients presenting with back and leg pain under 30 years of age.[
Radiographs, including flexion, extension views, and oblique views, confirm the diagnosis of Bertolotti’s syndrome. Both CT and MRI also demonstrate Bertolotti’s syndrome and also readily identify associated stenosis, osteophytes, and sclerosis adjacent to the articulation between the lumbar segment and ilium and/or sacrum.
Management of Bertolotti’s syndrome
Surgical resection of LSTV should be considered in patients presenting with intractable low back pain despite conservative treatment (e.g., physical therapy, nonsteroidal anti-inflammatory drugs, and localized anesthetic blocks in adults
Outcomes of surgery with Bertolotti’s syndrome
There are few reports for patients under 18 years of age treated for Bertolotti’s syndrome [
Bertolotti’s syndrome is seen in 10% of patients presenting with back and leg pain under 30 years of age.[
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given her consent for her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
There are no conflicts of interest.
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