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Techniques for restoring optimal spinal biomechanics to alleviate symptoms in Bertolotti syndrome: illustrative case – Lumbar Spinal Stenosis

The article discusses lumbosacral transitional vertebrae (LSTVs), which are congenital anomalies in the spinal segments of L5-S1. LSTVs can cause pain and clinical manifestations known as Bertolotti syndrome when the lowest lumbar vertebra fuses with the sacrum. The article presents a case of a 36-year-old female with severe low-back pain caused by a Castellvi type IIA LSTV. The pain did not respond to physical therapy and injections, but targeted steroid and bupivacaine injection of the pseudoarticulation provided complete pain relief for 2 weeks. The patient then underwent minimally invasive resection of the pseudoarticulation and experienced immediate improvement in her low-back pain. The article highlights that LSTVs can alter the biomechanics of the lumbosacral spine, leading to medically refractory pain that may require surgical intervention like resection, fusion, or decompression of the pathologic joint

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

BACKGROUND: Lumbosacral transitional vertebrae (LSTVs) are congenital anomalies that occur in the spinal segments of L5-S1. These vertebrae result from sacralization of the lowermost lumbar segment or lumbarization of the uppermost sacral segment. When the lowest lumbar vertebra fuses or forms a false joint with the sacrum (pseudoarticulation), it can cause pain and manifest clinically as Bertolotti syndrome.

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J Neurosurg Case Lessons. 2023 Dec 18;6(25):CASE23467. doi: 10.3171/CASE23467. Print 2023 Dec 18.ABSTRACTBACKGROUND: Lumbosacral transitional vertebrae (LSTVs) are congenital anomalies that occur in the spinal segments of L5-S1. These vertebrae result from sacralization of the lowermost lumbar segment or lumbarization of the uppermost sacral segment. When the lowest lumbar vertebra fuses or forms a false,

J Neurosurg Case Lessons. 2023 Dec 18;6(25):CASE23467. doi: 10.3171/CASE23467. Print 2023 Dec 18.

ABSTRACT

BACKGROUND: Lumbosacral transitional vertebrae (LSTVs) are congenital anomalies that occur in the spinal segments of L5-S1. These vertebrae result from sacralization of the lowermost lumbar segment or lumbarization of the uppermost sacral segment. When the lowest lumbar vertebra fuses or forms a false joint with the sacrum (pseudoarticulation), it can cause pain and manifest clinically as Bertolotti syndrome.

OBSERVATIONS: A 36-year-old female presented with severe right-sided low-back pain. Computed tomography was unremarkable except for a right-sided Castellvi type IIA LSTV. The pain proved refractory to physical therapy and lumbar epidural spinal injections, but targeted steroid and bupivacaine injection of the pseudoarticulation led to 2 weeks of complete pain relief. She subsequently underwent minimally invasive resection of the pseudoarticulation, with immediate improvement in her low-back pain. The patient continued to be pain free at the 3-year follow-up.

LESSONS: LSTVs alter the biomechanics of the lumbosacral spine, which can lead to medically refractory mechanical pain requiring surgical intervention. Select patients with Bertolotti syndrome can benefit from operative management, including resection, fusion, or decompression of the pathologic joint.

PMID:38109726 | DOI:10.3171/CASE23467

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Techniques for restoring optimal spinal biomechanics to alleviate symptoms in Bertolotti syndrome: illustrative case

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J Neurosurg Case Lessons. 2023 Dec 18;6(25):CASE23467. doi: 10.3171/CASE23467. Print 2023 Dec 18.ABSTRACTBACKGROUND: Lumbosacral transitional vertebrae (LSTVs) are congenital anomalies that occur in the spinal segments of L5-S1. These vertebrae result from sacralization of the lowermost lumbar segment or lumbarization of the uppermost sacral segment. When the lowest lumbar vertebra fuses or forms a false

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