Low back pain is an extremely frequent outpatient complaint across all fields of medicine. Among its surgical causes, lumbar stenosis is one of the most commonly seen in the neurosurgeon’s clinic. In this chapter, the authors present a case of a patient with classic symptoms of neurogenic claudication who is found to have multilevel degenerative lumbar stenosis on imaging. The authors discuss the evaluation of such patients by examination and imaging, with attention given to important alternatives in the differential diagnosis. They describe the surgical management of lumbar stenosis by conventional open decompression as well as newer minimally invasive techniques. Finally, the authors discuss key aspects of postoperative and complication management.
Abstract
Objective:
This article aims to provide more insight into the presentation, diagnosis, and treatment of Bertolotti's syndrome, which is a rare spinal disorder that is very difficult to recognize and diagnose correctly. The syndrome was first described by Bertolotti in 1917 and affects approximately 4 to 8% of the population. It is characterized by an enlarged transverse process at the most caudal lumbar vertebra with a pseudoarticulation of the transverse process and the sacral ala. It tends to present with low back pain and may be confused with facet and sacroiliac joint disease.
Methods:
In this case report, we describe a 40-year-old man who presented with low back pain and was eventually diagnosed with Bertolotti's syndrome. The correct diagnosis was made based on imaging studies which included computed tomographic scans, plain x-rays, and magnetic resonance imaging scans. The patient experienced temporary relief when the abnormal pseudoarticulation was injected with a cocktail consisting of lidocaine and steroids. In order to minimize the trauma associated with surgical treatment, a minimally invasive approach was chosen to resect the anomalous transverse process with the accompanying pseudoarticulation.
Results:
The patient did well postoperatively and had 97% resolution of his pain at 6 months after surgery.
Conclusion:
As with conventional surgical approaches, a complete knowledge of anatomy is required for minimally invasive spine surgery. This case is an example of the expanding utility of minimally invasive approaches in treating spinal disorders.
03:09 PM WITHDRAWN Abstract No. 200 Percutaneous thermal disc decompression versus percutaneous disc decompression like minimally invasive outpatient procedure of low back pain treatment: single-center one-year eperience