Minimally Invasive Surgical Treatment of Bertolotti's Syndrome: Case Report

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.

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RELATIONSHIP BETWEEN SACRALIZATION AND LOW BACK PAIN IN RURAL POPULATION

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i4.1302 ◽

2021 ◽

Vol 10 (4) ◽

pp. 3280-3283

Author(s):

Madhura Darware

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Vertebra ◽

Transverse Process ◽

Lumbosacral Spine ◽

Common Symptom ◽

Low Back ◽

Back Ache ◽

Fifth Lumbar Vertebra ◽

The Relationship

Sacralization is an embryo congenital defect in which the fifth lumbar vertebra is fused to the sacrum in various degrees. The prevalence of sacralization is 7.5 percent. Sacralization can be unilateral or bilateral. This disorder arises due to irregularities in the lumbosacral spine segmentation during development. Transverse process of the L5 on one side or both sides is wider than usual and fuses into the sacrum or ilium or both in the sacralization of the fifth lumbar vertebra. Low back pain is the most common symptom in most of the population throughout their lifetime. As low back pain is a leading cause of disability, interfering with quality of life and job outcomes our goal is to assess the association between sacralisation and low back pain. Purpose: To study the relationship between sacralization and low back pain. Because the role of sacralization throughout causing LBP is still controversial. This is the observational study which includes 55 participants who have low back ache. The participants are between the ages 60 to 70 years. The intensity of pain was assessed through NPRS. To assess the relationship between Sacralization and low back pain, all the participants were sent for Xray and the presence of Sacralization was assessed by X-ray. We found that there was a significant relationship between sacralization and low back pain. The patients with sacralization show the high intensity of low back pain. We concluded that Sacralization affects the lumbosacral spine in different ways and result in pain in lower back. And there is significant association of sacralization with low back ache.

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Percutaneous Peripheral Nerve Stimulation for Pain Reduction and Improvements in Functional Outcomes in Chronic Low Back Pain

Military Medicine ◽

10.1093/milmed/usy310 ◽

2019 ◽

Vol 184 (Supplement_1) ◽

pp. 537-541 ◽

Cited By ~ 3

Author(s):

Steven Cohen ◽

Christopher Gilmore ◽

Leonardo Kapural ◽

Steven Hanling ◽

Anthony Plunkett ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Minimally Invasive ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Chronic Low Back Pain ◽

Chronic Back Pain ◽

Peripheral Nerve Stimulation ◽

Low Back ◽

Invasive Approach

Abstract Chronic low back pain represents one of the most common sources of disability and a significant healthcare burden for the U.S. military. Present treatments for chronic back pain are often ineffective, poorly tolerated, invasive, destructive, and/or associated with complications and lead to the progression to invasive surgical procedures. There have been multiple calls for the development of a minimally invasive system that is effective without the risks or complications of existing surgical therapies, which could prevent the need for surgery and the recurrence of pain. The goal of this study was to evaluate a novel, minimally invasive approach using a percutaneous peripheral nerve stimulation (PNS) system designed to provide pain relief without surgery, to reduce complications, and provide a less-invasive treatment option. In nine subjects, percutaneous PNS improved participants’ function, as evidenced by clinically and statistically significant reductions in pain, disability, and pain interference. Subjects also experienced reductions in opioid and non-opioid analgesic medication usage and reported improvements in quality of life with treatment. There were no serious or unanticipated adverse events. These results demonstrate the potential of percutaneous PNS as a non-surgical therapy to treat chronic back pain without opioids.

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Bertolotti Syndrome

10.2310/pm.15017 ◽

2016 ◽

Author(s):

Jiang Wu ◽

Jianguo Cheng

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Compression Fracture ◽

Lumbar Vertebra ◽

Transverse Process ◽

Lumbosacral Spine ◽

Medial Branch ◽

Low Back ◽

Transitional Vertebra ◽

Lumbosacral Transitional Vertebra

Bertolotti syndrome is caused by a lumbosacral transitional vertebra, a congenital variation of the most caudal lumbar vertebra, characterized by an enlarged transverse process that articulates or fuses with the sacrum, ilium, or both. This syndrome accounts for 4.6 to 7% of cases of low back pain in adults and for more than 11% of patients with low back pain who are under 30 years old. The primary effect of lumbosacral transitional vertebra is reduced and asymmetrical motion between the transitional vertebra and the sacrum, resulting in early arthritic changes at pseudoarticulation; the secondary effect is the progressively compensatory modifications in the biomechanics of the mobile vertebral segments superior to the transitional vertebra related to restriction in rotation and bending motion at the lumbosacral articulation. Bertolotti syndrome should be considered in the differential diagnosis of low back pain. Clinical findings include low back pain in the midline or paramedian area that is reproduced with palpation along the base of the lumbosacral spine and near the posterosuperior iliac spine and aggravated by forward flexion, excessive extension, or lateralization of the back to the same side of the mega-apophysis. A plain x-ray is diagnostic; the extension-flexion lumbosacral radiographs in anteroposterior, lateral, and oblique views demonstrate lumbosacral transitional vertebra, with an enlarged unilateral or bilateral transverse process of the most distal lumbar vertebra, abnormally articulating with the ala of the sacrum and degenerative changes of the pseudarthrosis. Other imaging studies, such as computed tomography and magnetic resonance imaging of the lumbosacral spine and selective radiculography of the spinal nerve, could provide additional detailed anatomic information. Major differential diagnoses of Bertolotti syndrome include sacroiliac joint pain, myofascial pain, lumbar facet pain, lumbar disk herniation, compression fracture, and Baastrup disease/interspinous bursitis. These conditions are not mutually exclusive and, in fact, often coexist. A course of conservative management, including activity modification, medication management with nonsteroidal antiinflammatory drugs, muscle relaxants, and rehabilitative physical therapy, should be offered initially. Due to the multifactorial etiology of low back pain in patients with Bertolotti syndrome, procedures such as diagnostic intrapseudoarticular block for arthritis, medial branch block for facet arthropathy, diskography for diskogenic pain, and selective nerve roots block for radiculopathy can potentially help identify the primary and secondary origins of the pain. Surgical treatment of Bertolotti syndrome was only slightly better than conservative treatment and should only be used in very selective patients with disk pathology. To achieve long-term improvement by any of these therapeutic options, a continuing physical rehabilitation program is often needed. Key words: Bertolotti syndrome, intrapseudoarticular block, transitional lumbosacral vertebra, transverse process

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Minimally Invasive Microendoscopic Resection of the Transverse Process for Treatment of Low Back Pain with Bertolotti’s Syndrome

Case Reports in Orthopedics ◽

10.1155/2014/613971 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Yoichiro Takata ◽

Toshinori Sakai ◽

Kosaku Higashino ◽

Yuichiro Goda ◽

Kazuaki Mineta ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Minimally Invasive ◽

Lumbar Disc ◽

Transverse Process ◽

Local Injection ◽

Low Back ◽

Sciatic Pain ◽

Lumbar Segment ◽

Recurrent Lumbar Disc Herniation

Bertolotti’s syndrome is characterized by anomalous enlargement of the transverse process of the most caudal lumbar segment, causing chronic and persistent low back pain or sciatica. We describe the case of a 45-year-old woman who presented with left sciatic pain and low back pain due to a recurrent lumbar disc herniation at L4-5 with Bertolotti’s syndrome. Selective L5 nerve root block and local injection of lidocaine into the articulation between the transverse process and sacral ala temporarily relieved the left sciatic pain and low back pain, respectively. To confirm the effect of local injection on low back pain, we gave a second local injection, which once again relieved the low back pain. Microendoscopic resection of the pseudoarticulation region and discectomy successfully relieved all symptoms. This report illustrates the effectiveness of minimally invasive resection of the transverse process for the treatment of low back pain with Bertolotti’s syndrome.

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Poster 242 Chronic Low Back Pain in a 25-Year-Old Woman Due to Right L4 Transverse Process Articulation With the Sacrum: A Case Report

PM&R ◽

10.1016/j.pmrj.2011.08.273 ◽

2011 ◽

Vol 3 ◽

pp. S255-S255

Author(s):

Dustin M. Cole ◽

Brian Grogg

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Chronic Low Back Pain ◽

Transverse Process ◽

Low Back

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Treatment of Refractory Low Back Pain Caused by Degenerative Spine Disease with Minimally Invasive Techniques

Global Spine Journal ◽

10.1055/s-0034-1376724 ◽

2014 ◽

Vol 4 (1_suppl) ◽

pp. s-0034-1376724-s-0034-1376724

Author(s):

K. Vladimirovich Tyulikov ◽

K. Korostelev ◽

V. Manukovsky ◽

V. Litvinenko ◽

V. Badalov

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Minimally Invasive ◽

Low Back ◽

Minimally Invasive Techniques ◽

Degenerative Spine ◽

Degenerative Spine Disease ◽

Invasive Techniques ◽

Spine Disease

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Critical analysis and unique management of Gridhrasi w.s.r. to Sciatica - A Case Report

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v3i4.13310 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Dr. Rangarajan B. ◽

Dr. Muralidhara .

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Total Population ◽

The Body ◽

Walking Distance ◽

Common Symptom ◽

Low Back ◽

Short Term ◽

Lower Back

Gridhrasi (Sciatica) is a disorder in which low back pain is found, that spreads through the hip, to the back of the thigh and down the inside of the leg. Mechanical low back pain (LBP) remains the second most common symptom related reason for seeing a physician. 85% of total population will experience an episode of mechanical LBP at some point during their lifetime. Fortunately, the LBP resolves for the vast majority within 2-4 weeks. There are many causes for low back pain, however true sciatica is a symptom of inflammation or compression of the sciatica nerve. The sciatica nerve carries impulses between nerve roots in the lower back and the muscles and nerve of the buttocks, thighs and lower legs. Compression of a nerve root often occurs as a result of damage to one of the discs between the vertebrae. In some cases, sciatic pain radiate from other nerves in the body. This is called referred pain. Pain associated with sciatica often is severe, sharp and shooting. It may be accompanied by other symptom, such as numbness, tingling, weakness and sensitivity to touch. There is only conservative treatment giving short term relief in pain or surgical intervention with side effect. But these are not successful and therefore those who are suffering from this are always in search of result oriented remedy. Walking distance and SLR test were taken for assessment parameter, VAS score was adopted for pain. Before treatment patient was not able to walk even 4 to 5 steps due to severe pain, was brought on stretcher and his SLR was 30° of right side. After 22 days of treatment he was able to walk up to 500 meters without any difficulty, SLR was changed to 60° and patient had got 80 % relief in pain. This case report showed that Ayurvedic protocol is potent and safe in the treatment of Gridhrasi.

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Cognitive–Evaluative Dimension of Pain in Neuropathic Pain Relapse in Sciatica: A Case Report

Medicina ◽

10.3390/medicina57070658 ◽

2021 ◽

Vol 57 (7) ◽

pp. 658

Author(s):

Tsubasa Kawasaki ◽

Takuya Yada ◽

Masahiro Ohira

Keyword(s):

Neuropathic Pain ◽

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Acute Phase ◽

Low Back ◽

Evaluative Dimension ◽

Long Duration ◽

Improvement Process ◽

Insight Into

The cognitive–evaluative (C–E) dimension of pain is commonly observed in patients with a relatively long duration of pain. However, little is known about the effects of pain relapse on the C–E dimension of pain. Moreover, the improvement process of the C–E dimension of pain following treatment is unknown. The objective of this case report was to (a) demonstrate that the C–E dimension was affected in the acute phase of neuropathic pain in cases of pain relapse, and (b) demonstrate the improvement process of the C–E dimension of pain. A woman was diagnosed with low back pain (LBP) and sciatica. The patient had previously experienced symptoms of LBP and sciatica; thus, this episode was a case of pain relapse. At the beginning of rehabilitation, the C–E dimension of pain was present in addition to the sensory–discriminative (S–D) dimension of pain. It was observed that improvement of the C–E dimension of pain was delayed in comparison with that of the S–D dimension of pain. The C–E dimension of pain was observed with pain relapse even though it was in the acute phase of pain. This case provides a novel insight into the C–E dimension of pain. Moreover, the delay in improving the C–E dimension of pain indicates a difference in the improvement process for each pain dimension.

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