scholarly journals A case of Bertolotti’s syndrome as a cause of sciatica

2021 ◽  
Vol 12 ◽  
pp. 516
Author(s):  
Sarah Kawtharani ◽  
Shadi Abdelatif Bsat ◽  
Mohamad El Housheimy ◽  
Charbel Moussalem ◽  
Adham Halaoui ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
Invasive Approach ◽  
Surgery Patient ◽  
Patient Reported ◽  
Disc Herniations ◽  
Sacral Segment ◽  
The Right ◽  
Lumbosacral Transitional Vertebrae

Background: Bertolotti’s syndrome (i.e., varying extent of fusion between the last lumbar vertebra and the first sacral segment) or lumbosacral transitional vertebrae is a rare cause of back pain. Notably, this syndrome is one of the differential diagnoses for patients with refractory back pain/sciatica. Case Description: A 71-year-old male presented with low back pain of 3 years duration that radiated into the right lower extremity resulting in numbness in the L5 distribution. He then underwent a minimally invasive approach to resect the L5 “wide” transverse process following the CT diagnosis of Bertolotti’s syndrome. Prior to surgery, patient reported pain that was exacerbated by ambulation that resolved post-operative. Conclusion: Bertolotti’s syndrome is one of the rare causes of sciatica that often goes undiagnosed. Nevertheless, it should be ruled out for patients with back pain without disc herniations or other focal pathology diagnosed on lumbar MR scans.

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

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS454-ONS455 ◽  
Author(s):  
Kene T. Ugokwe ◽  
Tsu-Lee Chen ◽  
Eric Klineberg ◽  
Michael P. Steinmetz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
Low Back ◽  
X Rays ◽  
Invasive Approach

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.

Bertolotti Syndrome With Articulated L5 Transverse Process Causing Intractable Back Pain: Surgical Video Showcasing a Minimally Invasive Approach for Disconnection: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Zachary D Johnson ◽  
Salah G Aoun ◽  
Vin Shen Ban ◽  
Tarek Y E l Ahmadieh ◽  
Benjamin Kafka ◽  
...  
Keyword(s):  
Back Pain ◽  
Minimally Invasive ◽  
Clinical Symptoms ◽  
Symptomatic Relief ◽  
Transverse Process ◽  
Ethical Review ◽  
Invasive Approach ◽  
University Of Texas ◽  
Institutional Review ◽  
Patient Consent

Abstract Bertolotti syndrome is a commonly missed cause of intractable back pain that affects 4% to 8% of the general population. It involves the congenital malformation of a transitional lumbosacral vertebra, with total or partial and unilateral or bilateral transverse process (TP) fusion or articulation to the sacrum. The pain can be debilitating, and the tethering of the spine to the sacrum can encourage deformity formation in the coronal plane and lead to early degenerative changes, especially if present only unilaterally. We present the case of a 24-yr-old woman with no notable prior medical history who presented with years of lower axial back pain radiating to her thighs, which limited her activities of daily living and was resistant to conservative management. Her imaging showed an abnormally large left L5 TP, which was articulated to the sacrum, and signs of early coronal deformity. She had responded almost completely to repeated steroid injections into the TP-sacral joint, but that effect was very transient. Informed patient consent was obtained prior to her surgery. She underwent a minimally invasive tube disconnection of the abnormal joint with partial distal resection of the TP, and her symptoms completely resolved. This case highlights the importance of correlating clinical symptoms with aberrant anatomy, and the role of selective surgery in providing symptomatic relief. This case report was written in compliance with our institutional ethical review board approval, and patient consent was waived in light of the retrospective and deidentified nature of the data presented in accordance with the University of Texas Southwestern institutional review board.

Femoral nerve entrapment in a dog with diffuse idiopathic skeletal hyperostosis

2015 ◽  
Vol 28 (02) ◽  
pp. 151-154 ◽  
Author(s):  
J. Culvenor ◽  
C. Bailey ◽  
S. Davies ◽  
A. Lai
Keyword(s):  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Femoral Nerve ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
Nerve Entrapment ◽  
Resonance Imaging ◽  
Neurological Abnormality ◽  
Femoral Neuropathy ◽  
Muscle Groups ◽  
The Right

SummaryObjective: To report femoral neuropathy caused by nerve entrapment associated with diffuse idiopathic skeletal hyperostosis (DISH).Study Design: Case report.Animal: Seven-year-old female spayed Boxer dog.Results: Entrapment of the right femoral nerve due to DISH caused a femoral nerve deficit and atrophy of muscle groups associated with the affected nerve. A combination of computed tomography and magnetic resonance imaging was performed to provide a diagnosis. Amputation of the right transverse process of the sixth lumbar vertebra at the level of nerve entrapment relieved the neurological abnormality.Conclusions: Nerve entrapment leading to neurapraxia may occur concurrently with DISH and surgery in this case was successful in restoring function.Clinical relevance: Peripheral neuropathy from nerve entrapment should be considered in patients with DISH. Surgical amputation of impinging osseous structures may be indicated for relief of femoral neuropathy.

scholarly journals RELATIONSHIP BETWEEN SACRALIZATION AND LOW BACK PAIN IN RURAL POPULATION

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.

scholarly journals An unusual internal carotid artery compression as a possible cause of Eagle syndrome – A novel hypothesis and an innovative surgical technique

2019 ◽  
Vol 10 ◽  
pp. 174 ◽  
Author(s):  
Karol Galletta ◽  
Francesca Granata ◽  
Marcello Longo ◽  
Concetta Alafaci ◽  
Francesco S. De Ponte ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Transverse Process ◽  
Styloid Process ◽  
Lower Lip ◽  
Patient Reported ◽  
Eagle Syndrome ◽  
The Right

Background: Eagle syndrome (ES) is a rare symptomatic condition generally caused by an elongated styloid process (SP) or calcification of the stylohyoid complex. On the diagnosis is made, its treatment remains subjective since the indications for surgical intervention are still not standardized. Although styloidectomy is the surgical treatment of choice, no consensus exists regarding the transcervical or/and transoral route. Here, we report our experience in a patient with bilateral internal carotid artery (ICA) dissection caused by ES, who underwent innovative surgical technique. Case Description: A 53-year-old man, with the right-sided middle cerebral artery acute stroke, underwent computed tomography angiography 3 days after a successful endovascular treatment. The study showed a bilateral ICA dissection with bilateral hypertrophic SPs and a close relationship of ICAs with both SPs anteriorly and C1 transverse process posteriorly. Considering the occurrence of ICA compression by a styloid/C1 transverse process juxtaposition, the patient underwent the left partial C1 transversectomy by an extraoral approach. A temporary paresis of the ipsilateral lower lip lasted 1 month, with a partial remission after 3 months. The patient reported significant improvement of symptoms with a good esthetics and functional outcome. Conclusion: A styloid/C1 transverse process juxtaposition should be considered as an alternative pathogenetic mechanism in vascular ES. When a posterior ICA compression by C1 transverse process is present, a bone reshaping of C1 rather than a conventional styloidectomy can be considered an efficacious treatment which allows a good preservation of the styloid muscles and ligaments.

Bertolotti Syndrome

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  

scholarly journals Non-invasive approach in the treatment of temporomandibular joint osteoarthritis

2020 ◽  
pp. 79-79
Author(s):  
Andjela Milojevic-Samanovic ◽  
Dejan Zdravkovic ◽  
Stefan Velickovic ◽  
Milica Jovanovic ◽  
Marko Milosavljevic
Keyword(s):  
Temporomandibular Joint ◽  
Muscle Tension ◽  
Masticatory Muscles ◽  
Invasive Approach ◽  
Non Invasive ◽  
Temporomandibular Joint Osteoarthritis ◽  
Patient Reported ◽  
Orofacial Region ◽  
The Right ◽  
Bone Structures

Introduction. Temporomandibular dysfunction (TMD) is a set of disorders that involve the masticatory muscles, the temporomandibular joint (TMJ) and its associated structures. Osteoarthritis (OA), as one of the forms of TMD, leads to permanent changes in the bone structures of TMJ. These changes can be the cause of serious functional disorders of the TMJ. Case outline. This article describes a case of a 24-year-old female patient who sought help due to pain and swelling in the area of the right and left TMJ, accompanied by muscular tension, severe headaches, which did not respond to medication. ?fter establishing the diagnosis, we have applied a therapy in the treatment of the bilateral OA of TMJ, where we used non-invasive methods. Six months later, the patient reported the absence of pain, swelling, headache, and muscle tension in the orofacial region. Conclusion. There is no ?gold standard? for the management of ?? of ???. In our study, non-invasive therapy had a positive effect, where we achieved success in eliminating pain, increasing range of motion of the lower jaw, stopping the progression of the disease and advancing quality of life.

Mitral Re-Repair and Right Coronary Fistula Closure Advantage of Minimally Invasive Approach

2010 ◽  
Vol 5 (6) ◽  
pp. 456-459 ◽  
Author(s):  
Vincenzo Giordano ◽  
Jan G. Grandjean
Keyword(s):  
Mitral Valve ◽  
Right Atrium ◽  
Mild Hypothermia ◽  
Posterior Wall ◽  
Coronary Arteriography ◽  
Coronary Fistula ◽  
Invasive Approach ◽  
Concomitant Procedure ◽  
Echocardiographic Images ◽  
The Right

A 51-year-old man developed severe mitral regurgitation 10 years after previous mitral valve repair; the echocardiographic images showed a remarkable eccentric jet toward posterior wall of left atrium associated with a high degree of pulmonary vein retrograde flow. The coronary arteriography pointed out no pathologic lesions but a coronary fistula from the proximal right coronary to the right atrium. The standard approach was avoided, and a right anterolateral minithoracotomy was chosen, providing an excellent view. Under cardiopulmonary bypass and mild hypothermia, the mitral valve was re-repaired, and a new ring was implanted. After aortic cross-clamp release, the right coronary fistula was closed through the right atrium. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. In such a high-risk reintervention and concomitant procedure, we think that this different approach may represent a feasible and reliable alternative.

scholarly journals Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

2020 ◽  
Vol 38 (11) ◽  
pp. 2863-2872 ◽  
Author(s):  
Malte W. Vetterlein ◽  
◽  
Luis A. Kluth ◽  
Valentin Zumstein ◽  
Christian P. Meyer ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Urethral Stricture ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Patient Reported Outcome Measure ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
Surgery Patient ◽  
Patient Reported ◽  
Radiation Induced

Abstract Objectives To evaluate objective treatment success and subjective patient-reported outcomes in patients with radiation-induced urethral strictures undergoing single-stage urethroplasty. Patients and methods Monocentric study of patients who underwent single-stage ventral onlay buccal mucosal graft urethroplasty for a radiation-induced stricture between January 2009 and December 2016. Patients were characterized by descriptive analyses. Kaplan–Meier estimates were employed to plot recurrence-free survival. Recurrence was defined as any subsequent urethral instrumentation (dilation, urethrotomy, urethroplasty). Patient-reported functional outcomes were evaluated using the validated German extension of the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM). Results Overall, 47 patients were available for final analyses. Median age was 70 (IQR 65–74). Except for two, all patients had undergone pelvic radiation therapy for prostate cancer. Predominant modality was external beam radiation therapy in 70% of patients. Stricture recurrence rate was 33% at a median follow-up of 44 months (IQR 28–68). In 37 patients with available USS PROM data, mean six-item LUTS score was 7.2 (SD 4.3). Mean ICIQ sum score was 9.8 (SD 5.4). Overall, 53% of patients reported daily leaking and of all, 26% patients underwent subsequent artificial urinary sphincter implantation. Mean IIEF-EF score was 4.4 (SD 7.1), indicating severe erectile dysfunction. In 38 patients with data regarding the generic health status and treatment satisfaction, mean EQ-5D index score and EQ VAS score was 0.91 (SD 0.15) and 65 (SD 21), respectively. Overall, 71% of patients were satisfied with the outcome. Conclusion The success rate and functional outcome after BMGU for radiation-induced strictures were reasonable. However, compared to existing long-term data on non-irradiated patients, the outcome is impaired and patients should be counseled accordingly.

scholarly journals Effective erector spinae plane block for postoperative analgesia in a pyothorax patient who underwent emergency re-open thoracotomy—a case report

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Izumi Kawagoe ◽  
Daizoh Satoh ◽  
Mariko Fukui ◽  
Kenji Suzuki ◽  
Eiichi Inada
Keyword(s):  
Postoperative Analgesia ◽  
Transverse Process ◽  
Erector Spinae ◽  
Open Thoracotomy ◽  
Case Presentation ◽  
Lung Lobectomy ◽  
Erector Spinae Plane Block ◽  
Lower Lung ◽  
The Right ◽  
Vein Stenosis

Abstract Background The appropriate choice of postoperative analgesia for pyothorax surgery is unclear since local infection could contaminate the catheter used for regional blocks and bacteremia can lead to disordered coagulation. We performed erector spinae plane block (ESPB) in a pyothorax patient undergoing emergency re-open thoracotomy. Case presentation An 81-year-old male with internal jugular vein stenosis on aspirin therapy was scheduled for pyothorax drainage and residual middle lobectomy 14 days after he underwent open right lower lung lobectomy for lung cancer. ESPB was performed with injection of 20 ml of 0.375% levobupivacaine at the Th5 transverse process of the right side under ultrasound guidance. Although he needed intravenous pentazocine for pain on postoperative day 0, no more analgesics were required postoperatively. NRS score ranged from 0 to 1 thereafter. Conclusions ESPB provided effective postoperative analgesia following emergency re-open thoracotomy for our pyothorax patient. ESPB might be the appropriate choice for postoperative analgesia following pyothorax surgery.

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