Transitional lumbosacral vertebrae and low back pain: diagnostic pitfalls and management of Bertolotti's syndrome

Author:

Almeida Daniel Benzecry de1,Mattei Tobias Alécio1,Sória Marília Grando1,Prandini Mirto Nelso2,Leal André Giacomelli1,Milano Jerônimo Buzzeti1,Ramina Ricardo1

Affiliation:

1. Instituto de Neurologia de Curitiba, Brazil

2. Universidade Federal de São Paulo, Brazil

Abstract

OBJECTIVE: Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. METHOD: We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. RESULTS: Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. CONCLUSION: There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.

Publisher

FapUNIFESP (SciELO)

Subject

Neurology,Clinical Neurology

Reference27 articles.

1. Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain;Brault JS;Spine,2001

2. Bertolotti's syndrome revisited. Transitional vertebrae of the lumbar spine;Elster AD;Spine,1989

3. Contributo alla conoscenza dei vizi di differenzazione regionale del rachide con speciale riguardo all assimilazione sacrale della v. lombare;Bertolotti M;Radiol Med,1917

4. Review article. Can an anomalous lumbo-sacral or lumbo-iliac articulation cause low back pain?: A retrospective study of 12 cases;Avimadje M;Rev Rhum Engl Ed,1999

5. Bertolotti's syndrome: a cause of back pain in young people;Quinlan JF;J Bone Joint Surg,2006

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