• Harish Babu, Carlito Lagman, Terrence T Kim, Marshall Grode, JohnsonJ PatrickJPDepartment of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States., and Doniel Drazin.
• Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States.
• Surg Neurol Int. 2017 Jan 1; 8: 236.

BackgroundBertolotti's syndrome is characterized by enlargement of the transverse process at the most caudal lumbar vertebra with a pseudoarticulation between the transverse process and sacral ala. Here, we describe the use of intraoperative three-dimensional image-guided navigation in the resection of anomalous transverse processes in two patients with Bertolotti's syndrome.Case DescriptionsTwo patients diagnosed with Bertolotti's syndrome who had undergone the above-mentioned procedure were identified. The patients were 17- and 38-years-old, and presented with severe, chronic low back pain that was resistant to conservative treatment. Imaging revealed lumbosacral transitional vertebrae at the level of L5-S1, which was consistent with Bertolotti's syndrome. Injections of the pseudoarticulations resulted in only temporary symptomatic relief. Thus, the patients subsequently underwent O-arm neuronavigational resection of the bony defects. Both patients experienced immediate pain resolution (documented on the postoperative notes) and remained asymptomatic 1 year later.ConclusionIntraoperative three-dimensional imaging and navigation guidance facilitated the resection of anomalous transverse processes in two patients with Bertolotti's syndrome. Excellent outcomes were achieved in both patients.

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