Bertolotti syndrome: initial management and main surgical strategies

Описание

RATIONALE: Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. Due to possible other comorbidities present in the spine, the diagnosis of Bertolotti's syndrome (BS) is not straightforward thus making it a diagnosis of exclusion. BS consists of low-back pain caused by LSTVs and associated biomechanical spinal changes, and associated spinal disorders like: lumbar disc degeneration or disc herniation; degeneration of the anomalous joint between the LSTV-TP and the sacrum; facet arthrosis ipsi-or contralateral to an unilateral fused or articulating LSTV; hypertrophy or broadened of the enlarged TP compressing the nerve root (far out syndrome); secondary lumbar scoliosis, more in asymmetric pseudo-joint. There is a lack of consensus regarding the cause, clinical significance, and treatment of this condition.
OBJECTIVE: The authors aim to review the most important aspects for the management of this syndrome, associated spinal abnormalities and discuss the most important features, including its own experience on the management of this syndrome.
METHODS: A literature review related to surgical treatment of BS was performed and the main aspects were presented. An author’s series of consecutive patients who had the diagnosis of symptomatic BS underwent minimally invasive paramedian tubular-based resection of the LSTV for BS were identified and also described, and in some cases, related spinal disorders were also surgically treated.
RESULTS: A series of 8 consecutive patients with chronic low-back pain associated with LSTV and BS, who had transient pain relief on pseudo-joint image-guided injection with steroid and anesthetics, were submitted to the minimally invasive-tubular microsurgical transverse processectomy and their cases were described here. Medical records were reviewed to identify demographics, associated spinal disorders, operative data, and outcome. The vast majority of the patients had very good result regarding the pain relieve related to the BS, only 1 patient who was submitted to lumbar fusion for disc degeneration and bilateral transverse processectomy had only temporary improvement of her pain, and there were no relevant surgical complication.
CONCLUSIONS: BS should be remembered as a possible etiology of low back pain, sometimes associated with other lumbar spinal disorders. Its proper diagnosis and management can be helpful for the treatment of this patients, which after a positive pseudo-joint injection-test, can be considered for surgery, like a minimally invasive-tubular microsurgical transverse processectomy.