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Kojo S, Takahashi K, Tsubakino T, Hashimoto K, Aizawa T, Tanaka Y. Lumbar radiculopathy due to Bertolotti's syndrome: Alternative method to reveal the "hidden zone" - A report of two cases and review of literature. J Orthop Sci 2024; 29:366-369. [PMID: 35305864 DOI: 10.1016/j.jos.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Shigeaki Kojo
- Department of Orthopaedic Surgery, Tohoku Central Hospital
| | - Kohei Takahashi
- Department of Orthopaedic Surgery, Tohoku Central Hospital; Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | | | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku Central Hospital; Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine.
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
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Zhu W, Ding X, Zheng J, Zeng F, Zhang F, Wu X, Sun Y, Ma J, Yin M. A systematic review and bibliometric study of Bertolotti's syndrome: clinical characteristics and global trends. Int J Surg 2023; 109:3159-3168. [PMID: 37318877 PMCID: PMC10583961 DOI: 10.1097/js9.0000000000000541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Bertolotti's syndrome is a prevalent congenital deformity. However, many physicians fail to include it in their differential diagnosis for low back pain (LBP), which results in missed diagnosis or misdiagnosis. There is still a lack of standardized treatment and management strategies for Bertolotti's syndrome. This study aimed to review the clinical characteristics and management of Bertolotti's syndrome and reports bibliometric insights in advancements in Bertolotti's syndrome research. METHODS Studies published until 30 September 2022 were systematically reviewed according to the PRISMA guidelines. Three independent reviewers extracted the data and assessed the quality and risk of bias of the studies based on the methodological index of non-randomized studies (MINORS). SPSS, VOS viewer, and the Citespace software were used for the systematic review, visual analysis, data mining, mapping, and clustering of the retrieved articles, which presented clear and visual presentations of the structural patterns of published research in graphs. RESULT A total of 118 articles, describing a total of 419 patients with Bertolotti's syndrome, were included. There was an upward trend with a steady increase in the number of publications. The world map distribution showed that most publications were predominantly from North America and Asia. The most cited articles were published in the following journals: Spine, J Bone Joint Surg, and Radiology. The mean age of the patients was 47.7 years, and 49.6% of them were male. A total of 159 (96.4%) patients had LBP symptoms. The mean symptom duration was 41.4 months (74.8%), and most of the patients had Castellvi type II. Disc degeneration was the most reported comorbid spinal diseases. The mean methodological index of non-randomized studies score was 4.16±3.95 points (range, 1-21). A total of 265 (68.3%) patients underwent surgical treatments. Minimally invasive surgical techniques, prevalence, image classification, and disc degeneration were the current main research areas of Bertolotti's syndrome. CONCLUSIONS The steady increase in the number of publications demonstrated the increased attention of researchers on this topic. Our results showed a significant prevalence of Bertolotti's syndrome in patients with LBP and a long symptom duration before the initiation of treatment. Surgical treatments were commonly used to treat patients with Bertolotti's syndrome after a non-effective conservative treatment. Minimally invasive surgical techniques, prevalence, image classification, and disc degeneration are the major research areas of Bertolotti's syndrome.
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Affiliation(s)
- Wenhao Zhu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Xing Ding
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Jiale Zheng
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Fan Zeng
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Fan Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Xuequn Wu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Yijun Sun
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
| | - Junming Ma
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Mengchen Yin
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine
- Postdoctoral Station, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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3
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Mikula AL, Lakomkin N, Ransom RC, Flanigan PM, Waksdahl LA, Pennington Z, Sharma MS, Elder BD, Fogelson JL. Operative Treatment of Bertolotti Syndrome: Resection Versus Fusion. World Neurosurg 2022; 165:e311-e316. [PMID: 35717016 DOI: 10.1016/j.wneu.2022.06.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the outcomes of joint resection versus fusion in patients who undergo operative treatment for Bertolotti syndrome. METHODS A chart review identified patients with Bertolotti syndrome who underwent operative treatment, consisting of either Bertolotti joint decompression/resection or fusion across the abnormal transitional lumbosacral vertebrae. Patients with other symptomatic operative spinal disease were excluded. RESULTS Twenty-seven patients (9 men, 18 women) were identified for inclusion in the study with an average age of 40 ± 16 years, body mass index of 27 ± 5, and follow-up of 39 ± 48 months. Most patients presented with back pain (74%) or leg pain (48%) for an average duration of 61 ± 54 months. Nineteen (70%) presented with a Castellvi subtype 2a Bertolotti joint with computed tomography as the most common method for radiographic diagnosis (56%). When comparing long-term pain improvement (>12 months) after fusion (n = 9) versus joint resection (n = 18), more fusion patients reported improvement in their pain (78%) compared to joint resection (28%, P = 0.037). There was not a statistically significant difference in the short-term pain improvement (<6 months) between the fusion (100%) and resection (78%) patients (P = 0.27). There was no statistically significant difference between the two groups in terms of age, sex, body mass index, presenting symptoms, symptom duration, Bertolotti injection response, follow up, Castellvi subtype, and complications. CONCLUSIONS Patients with Bertolotti syndrome who underwent surgical fusion across the transitional lumbosacral vertebrae had a higher rate of long-term pain improvement compared to patients who had resection of the abnormal pseudoarticulation.
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Affiliation(s)
- Anthony L Mikula
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Nikita Lakomkin
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan C Ransom
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick M Flanigan
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura A Waksdahl
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zach Pennington
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Manish S Sharma
- Department of Neurological Surgery, Mayo Clinic, Mankato, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy L Fogelson
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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4
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Chang CJ, Chiu YP, Ji HR, Chu CH, Chiu CD. Surgical interventions for Bertolotti's syndrome: case report and review of unsatisfactory cases in the literature. BMC Surg 2022; 22:36. [PMID: 35109844 PMCID: PMC8812153 DOI: 10.1186/s12893-022-01498-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Bertolotti’s syndrome (BS) is characterized by the enlargement of transverse processes in caudal lumbar segments, causing chronic and persistent low back pain or sciatica. The present study aimed to describe our surgical technique for BS treatment and to review existing literature describing unsatisfactory outcomes.
Case presentation We report a patient who complained of lower back pain and soreness that intermittently radiated to his left leg for longer than 10 years. Based on an examination of his symptoms and signs, including imaging and electrical physiology assessments, in addition to the report of temporary pain relief after a local steroid injection to a diagnostic trigger site (articulation between the transverse process and the sacral ala or iliac crest), the patient was diagnosed with BS. The applied surgical techniques included minimally invasive, three-dimensional C-arm guidance, a tubing approach, and microscopic and bone cavitron ultrasonic surgical aspirator–assisted operations. After surgery, improvements were reported on the visual analog scale (from 8 to 2 points on a 10-point scale) and the straight leg raising test for the left leg (20° to 90°) within 3 days. The patient gained an ordinary life and returned to work within one week of surgery, with no observed postoperative complications. Conclusions Minimally invasive tubular microscopic decompression and disarticulation is an effective method for treating BS. However, to achieve a successful outcome, it is recommended to use physician-proficient techniques that are in line with the patient’s diagnosis.
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Affiliation(s)
- Chun-Jen Chang
- Department of Neurosurgery, China Medical University Hospital, No.2, Yu-Der Road, North Area, Taichung, 40447, Taiwan, ROC.,Spine Center, China Medical University Hospital, Taichung, Taiwan
| | - You-Pen Chiu
- Department of Neurosurgery, China Medical University Hospital, No.2, Yu-Der Road, North Area, Taichung, 40447, Taiwan, ROC.,Spine Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Hui-Ru Ji
- Department of Neurosurgery, China Medical University Hospital, No.2, Yu-Der Road, North Area, Taichung, 40447, Taiwan, ROC.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chang-Hung Chu
- Department of Emergency, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Di Chiu
- Department of Neurosurgery, China Medical University Hospital, No.2, Yu-Der Road, North Area, Taichung, 40447, Taiwan, ROC. .,Spine Center, China Medical University Hospital, Taichung, Taiwan. .,Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan. .,School of Medicine, China Medical University, Taichung, Taiwan.
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5
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Dhanjani S, Altaleb M, Margalit A, Puvanesarajah V, Jain A. Pediatric Back Pain Associated with Bertolotti Syndrome: A Report of 3 Cases with Varying Treatment Strategies. JBJS Case Connect 2021; 11:01709767-202112000-00058. [PMID: 34788257 DOI: 10.2106/jbjs.cc.21.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Three pediatric patients with back pain associated with Bertolotti syndrome are presented. After failing conservative management, 1 patient underwent mega-apophysis resection, another underwent resection with decompression, and the final underwent posterior fusion. All patients had complete resolution of back pain and returned to full activity at final follow-up. CONCLUSION Lumbosacral transitional vertebrae are congenital anomalies spanning a spectrum from partial/complete L5 sacralization to partial/complete S1 lumbarization with varying clinical presentations. Identification of variable anatomy and symptoms guides surgical management. We present 3 cases with differing surgical techniques including pseudoarticulation resection, arthrodesis of the involved levels, and neuroforaminal decompression.
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Affiliation(s)
- Suraj Dhanjani
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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McGrath K, Schmidt E, Rabah N, Abubakr M, Steinmetz M. Clinical assessment and management of Bertolotti Syndrome: a review of the literature. Spine J 2021; 21:1286-1296. [PMID: 33676018 DOI: 10.1016/j.spinee.2021.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 02/03/2023]
Abstract
Bertolotti Syndrome is a diagnosis given to patients experiencing pain caused by the presence of a lumbosacral transitional vertebra (LSTV), which is characterized by enlargement of the L5 transverse process(es), with potential pseudoarticulation or fusion with the sacrum. The Castellvi classification system is commonly utilized to grade LSTVs based on the degree of contact between the L5 transverse process(es) and the sacrum. LSTVs present a diagnostic dilemma to the treating clinician, as they may remain unidentified on plain x-rays and even advanced imaging; additionally, even if the malformation is identified, patients with a LSTV may be asymptomatic or have nonspecific symptoms, such as low back pain with or without radicular symptoms. With low back pain being extremely prevalent in the general population; it can be difficult to implicate the LSTV as the source of this pain. Care should be taken however, to exclude Bertolotti Syndrome in patients under 30 years old presenting with persisting low back pain given its congenital origin. If a LSTV is identified, typically with acquisition of a MRI or CT scan of the lumbosacral spine, and there is an absence of a more compelling or obvious source for the patient's symptoms, a conservative, step-wise management plan is recommended. This may include assessing for improvement in symptoms with injections prior to proceeding with surgical intervention. Additional concerns arise from the biomechanical alterations that a LSTV induces in adjacent spinal levels, predisposing this patient population to a more rapid-onset of adjacent segment disease, raising the question as to the most appropriate surgery (resection of LSTV pseudoarticulation with or without fusion). Postoperative outcome data for patients undergoing surgical treatment is limited in the literature with promising, but variable, results. More large-scale, controlled studies must be performed to gain further insight into the ideal work-up and management of this pathology.
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Affiliation(s)
- Kyle McGrath
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Eric Schmidt
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas Rabah
- Case Western Reserve College of Medicine, Cleveland, OH, USA
| | | | - Michael Steinmetz
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Kanematsu R, Hanakita J, Takahashi T, Minami M, Tomita Y, Honda F. Extraforaminal entrapment of the fifth lumbar spinal nerve by nearthrosis in patients with lumbosacral transitional vertebrae. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2215-2221. [DOI: 10.1007/s00586-020-06460-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
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Kanematsu R, Hanakita J, Takahashi T, Tomita Y, Minami M. Pulsed Radiofrequency Treatment for Bertolotti’s Syndrome Presenting With Low Back Pain: Report of Four Cases. Pain Pract 2020; 20:568-570. [DOI: 10.1111/papr.12877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ryo Kanematsu
- Department of Spinal Disorders Center Fujieda Heisei Memorial Hospital Shizuoka Japan
| | - Junya Hanakita
- Department of Spinal Disorders Center Fujieda Heisei Memorial Hospital Shizuoka Japan
| | - Toshiyuki Takahashi
- Department of Spinal Disorders Center Fujieda Heisei Memorial Hospital Shizuoka Japan
| | - Yosuke Tomita
- Department of Spinal Disorders Center Fujieda Heisei Memorial Hospital Shizuoka Japan
| | - Manabu Minami
- Department of Spinal Disorders Center Fujieda Heisei Memorial Hospital Shizuoka Japan
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Louie CE, Hong J, Bauer DF. Surgical management of Bertolotti's syndrome in two adolescents and literature review. Surg Neurol Int 2019; 10:135. [PMID: 31528470 PMCID: PMC6744759 DOI: 10.25259/sni-305-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/05/2019] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
| | - Jennifer Hong
- 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
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Holm EK, Bünger C, Foldager CB. Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention. SICOT J 2017; 3:71. [PMID: 29243586 PMCID: PMC5731823 DOI: 10.1051/sicotj/2017055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022] Open
Abstract
Bertolotti’s syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I–V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient’s symptoms, especially patients diagnosed with “far out syndrome” treated with laminectomy. Clinical outcomes were more heterogenetic for patient’s treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient’s clinical outcome over time, whereas steroid injection only improves the patient’s symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS.
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Affiliation(s)
- Emil Kongsted Holm
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Cody Bünger
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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Iwasaki M, Akiyama M, Koyanagi I, Niiya Y, Ihara T, Houkin K. Double Crush of L5 Spinal Nerve Root due to L4/5 Lateral Recess Stenosis and Bony Spur Formation of Lumbosacral Transitional Vertebra Pseudoarticulation: A Case Report and Review. NMC Case Rep J 2017; 4:121-125. [PMID: 29018654 PMCID: PMC5629357 DOI: 10.2176/nmccrj.cr.2016-0308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/24/2017] [Indexed: 11/20/2022] Open
Abstract
We present a case of double-crushed L5 nerve root symptoms caused by inside and outside of the spinal canal with spur formation of the lumbosacral transitional vertebra (LSTV). A 78-year-old man presented with 7-year history of moderate paresis of his toe and left leg pain when walking. Magnetic resonance imaging (MRI) revealed spinal stenosis at the L3/4 and 4/5 spinal levels and he underwent wide fenestration of both levels. Leg pain disappeared and 6-min walk distance (6MWD) improved after surgery, however, the numbness in his toes increased and 6MWD decreased 9 months after surgery. Repeated MR and 3D multiplanar reconstructed computed tomography (CT) images showed extraforaminal impingement of the L5 root by bony spur of the left LSTV. He underwent second decompression surgery of the L5/S via the left sided Wiltse approach, resulting in the improvement of his symptoms. The impingement of L5 spinal nerve root between the transverse process of the fifth lumbar vertebra and the sacral ala is a rare entity of the pathology called "far-out syndrome (FOS)". Especially, the bony spur formation secondary to the anomalous articulation of the LSTV (LSPA) has not been reported. These articulations could be due to severe disc degeneration, following closer distance and contact between the transverse process and the sacral ala. To our knowledge, this is the first report describing a case with this pathology and may be considered in cases of failed back surgery syndromes (FBSS) of the L5 root symptoms.
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Affiliation(s)
- Motoyuki Iwasaki
- Neurosurgical Department, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Masahiko Akiyama
- Spine Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Izumi Koyanagi
- Hokkaido Neurosurgical Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Yoshimasa Niiya
- Neurosurgical Department, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Tatsuo Ihara
- Neurosurgical Department, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Ise S, Abe K, Orita S, Ishikawa T, Inage K, Yamauchi K, Suzuki M, Sato J, Fujimoto K, Shiga Y, Kanamoto H, Inoue M, Kinoshita H, Takahashi K, Ohtori S. Surgical treatment for far-out syndrome associated with abnormal fusion of the L5 vertebral corpus and L4 hemivertebra: a case report. BMC Res Notes 2016; 9:329. [PMID: 27352836 PMCID: PMC4924308 DOI: 10.1186/s13104-016-2123-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Far-out syndrome was reported by Wiltse et al. in 1984, which is a condition characterized by L5 spinal nerve radiculopathy due to nerve compression between the L5 transverse process and sacral alar. Although many cases of far-out syndrome have been reported, to our knowledge, the present case firstly showed far-out syndrome due to assimilated L4 hemivertebra and L5 vertebra through which abnormal nerve root passed. CASE PRESENTATION A 71-year-old man presented with left lower back pain and intermittent claudication accompanied by severe left buttock pain. Radiological examination showed assimilation between the L4 hemivertebra and L5 vertebra, which had two pedicles on the right side, with no canal stenosis. However, computed tomography and magnetic resonance imaging of coronal sections showed extraforaminal stenosis between the L5 transverse process and sacral alar, whereby the L5 spinal nerve was pinched ("far-out lesion"), and an abnormal nerve root passage in the assimilated vertebral corpus. We performed transforaminal lumbar interbody fusion, then resected the L5 transverse process to decompress the extraforaminal stenosis, and finally installed pedicle screws, but not at the one of pedicles of the assimilated vertebra in order to prevent nerve injury. Postoperatively, the patient had no symptoms up to 1.5 years after the surgery. CONCLUSION The current case suggests the importance of detailed preoperative examination of patients with anatomical abnormalities such as assimilated vertebrae, which may result in incorrect diagnosis and failed surgery.
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Affiliation(s)
- Shohei Ise
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Tetsuhiro Ishikawa
- Department of Orthopaedic Surgery, Sanmu Medical Center, 167 Naruto, Sanmu, Chiba, 289-1326, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Kazuyo Yamauchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Miyako Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Jun Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Hirohito Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Hideyuki Kinoshita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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13
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Tschugg A, Tschugg S, Hartmann S, Rhomberg P, Thomé C. Far caudally migrated extraforaminal lumbosacral disc herniation treated by a microsurgical lateral extraforaminal transmuscular approach: case report. J Neurosurg Spine 2016; 24:385-8. [DOI: 10.3171/2015.7.spine15342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 33-year-old man presented with moderate low-back pain and L-5 radiculopathy that progressed to severe paresis of L-5. On initial imaging, a corresponding spinal lesion was overlooked. Further CT and contrast-enhanced MRI demonstrated a presacral mass along the L-5 root far extraforaminally. A herniated disc was suspected, but with standard imaging a schwannoma could not be ruled out. The presacral L-5 root was explored via a microsurgical lateral extraforaminal transmuscular approach. To the best of the authors' knowledge, there have been no reports of sequestered extraforaminal lumbosacral disc herniations that herniated into the presacral region.
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Affiliation(s)
| | | | | | - Paul Rhomberg
- 3Department of Neuroradiology, Medical University of Innsbruck; and
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Jancuska JM, Spivak JM, Bendo JA. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome. Int J Spine Surg 2015; 9:42. [PMID: 26484005 DOI: 10.14444/2042] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. This review will focus on the clinical significance of LSTV, disruptions in normal spine biomechanics, imaging techniques, diagnosis, and treatment. METHODS A Pubmed search using the specific key words "LSTV," "lumbosacral transitional vertebrae," and "Bertolotti's Syndrome" was performed. The resulting group of manuscripts from our search was evaluated. RESULTS LSTV are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTV are often inaccurately detected and classified on standard AP radiographs and MRI. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increase accuracy. Uncertainty regarding the cause, clinical significance, and treatment of LSTV persists. Some authors suggest an association between LSTV types II and IV and low back pain. Pseudoarticulation between the transverse process and the sacrum creates a "false joint" susceptible to arthritic changes and osteophyte formation potentially leading to nerve root entrapment. The diagnosis of symptomatic LSTV is considered with appropriate patient history, imaging studies, and diagnostic injections. A positive radionuclide study along with a positive effect from a local injection helps distinguish the transitional vertebra as a significant pain source. Surgical resection is reserved for a subgroup of LSTV patients who fail conservative treatment and whose pain is definitively attributed to the anomalous pseudoarticulation. CONCLUSIONS Due to the common finding of low back pain and the wide prevalence of LSTV in the general population, it is essential to differentiate between symptoms originating from an anomalous psuedoarticulation from other potential sources of low back pain. Further studies with larger sample sizes and longer follow-up time would better demonstrate the effectiveness of surgical resection and help guide treatment.
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Affiliation(s)
| | - Jeffrey M Spivak
- Department of Orthopaedic Surgery and Hospital for Joint Diseases, New York University School of Medicine, New York, NY, USA
| | - John A Bendo
- Department of Orthopaedic Surgery and Hospital for Joint Diseases, New York University School of Medicine, New York, NY, USA
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