• Pain physician · Sep 2017

    Decompressive L5 Transverse Processectomy for Bertolotti's Syndrome: A Preliminary Study.

    • Chang Il Ju, Seok Won Kim, Jong Gyue Kim, Seung Myung Lee, Ho Shin, and Hyeun Young Lee.
    • Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea.
    • Pain Physician. 2017 Sep 1; 20 (6): E923-E932.

    BackgroundBertolotti's syndrome is a spinal disorder characterized by abnormal enlargement of the transverse process of the most caudal lumbar vertebra. The L5 transverse process may be enlarged either unilaterally or bilaterally and may articulate or fuse with the sacrum or ilium. Pseudoarticulation between the transverse process of the L5 and the alar of the sacrum can cause buttock pain and leg pain. In addition, the L4 exiting nerve root could be compressed by an enlarged L5 transverse process. The authors could have obtained satisfactory results from the selected cases of Bertolotti's syndrome by applying a selective transverse processectomy of the L5.ObjectiveThe objective of this study is to determine the effectiveness of L5 transverse processectomy for symptomatic Bertolotti's syndrome.Study DesignA retrospective study.MethodsA total of 256 patients with Bertolotti's syndrome who had severe buttock pain and unilateral or bilateral radiating leg pain were selected. The correct diagnosis was made based on imaging studies which included computed tomography (CT), plain x-rays, and magnetic resonance imaging (MRI). The final diagnosis was made by confirming pain relief from anesthetic block. A total of 87 patients were classified into 2 groups: group A included 50 patients whose pain was relieved by block into the pseudoarticulation and group B included 37 patients whose pain was relieved by block into the L4 exiting nerve root. A total of 61 cases (group A: 39 cases, group B: 22 cases) were selected as pure L5 transverse processectomy.Outcome MeasuresThe primary outcome measures were reduction in pain scores and improvement in quality of life.ResultsAmong 61 patients, there were 19 men and 42 women. The mean age of the patients was 53.2 ± 12 years (group A: 57.8 ± 14 years [16 - 86 years], group B: 53.4 ± 14 years [27 - 77 years]). The mean follow-up period was 6.5 months. The patients' mean visual analog scale (VAS) prior to surgery was 7.54 ± 0.81 (group A: 7.59 ± 0.93, group B: 7.50 ± 0.86), and the mean postoperative VAS was 2.86 ± 1.67 (group A: 3.82 ± 1.59, group B: 2.05 ± 1.00). According to Macnab's criteria, 12 patients showed excellent results (group A: 3, group B: 9), 41 patients showed good results (group A: 11, group B: 30), 6 patients showed fair results (group A: 5, group B: 1), and 2 patients showed poor results (group A: 2, group B: 0). Thus, satisfactory results were achieved in 86.89% of the cases.ConclusionIn patients with Bertolotti's syndrome, pseudoarticulation as well as L4 nerve root compression can be the source of buttock pain and lower extremity pain. Bisectional cutting of the L5 transverse process and decompression of the L4 nerve root could be an optimal treatment for Bertolotti's syndrome, and it may be easily approached by the paraspinal approach.LimitationsThis is a retrospective study and only offers one-year follow-up data for patients with Bertolotti's syndrome who have undergone L5 transverse process resection.Key words: Bertolotti's syndrome, pseudoarticulation, L5 transverse processectomy, paraspinal approach.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.