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Hauser AL, Von Glinski A, Noriega Urena JF, Lange T, Murad S, Lewik G, Schulte T. [Bertolotti syndrome: an often overlooked cause of specific back pain]. ORTHOPADIE (HEIDELBERG, GERMANY) 2025:10.1007/s00132-025-04656-1. [PMID: 40301172 DOI: 10.1007/s00132-025-04656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Lumbosacral transitional vertebrae (LSTV) are common, with a prevalence of 15-35%, and can be a cause of specific low back pain. The insufficient awareness of this anomaly often leads to delayed diagnosis and treatment. OBJECTIVE This study explains the anatomical and biomechanical basis of Bertolotti syndrome and discusses diagnostic and therapeutic options. MATERIALS AND METHODS This systematic review was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The SCOPE criteria (Structuring Comparative Outcome Reporting in Epidemiology) were considered to ensure comprehensive and transparent reporting. A systematic search was performed in PubMed using the search terms 'Bertolotti', 'Bertolotti syndrome', and 'Lumbosacral transitional vertebrae' by a single investigator, resulting in the inclusion of 112 studies. Articles that were not available in English or German were excluded. RESULTS Patients with symptomatic Bertolotti syndrome often suffer from chronic low back pain and radiculopathies. Imaging techniques, particularly X‑rays and MRI, play a key role in diagnosis. Conservative treatments show limited success. Surgical resection of the transverse process (processectomy), especially after positive test infiltrations, leads to significant pain relief, particularly in younger patients without degenerative changes. DISCUSSION Treatment choice depends on individual anatomy and the presence of degenerative changes. While conservative measures are initially recommended, processectomy shows promising results in carefully selected patients. Fusion surgeries should only be considered in cases of instability. Further studies are needed to confirm the effectiveness of invasive procedures.
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Affiliation(s)
- Anna-Lena Hauser
- St. Josef-Hospital Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
| | - Alexander Von Glinski
- St. Josef-Hospital Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | | | - Tobias Lange
- St. Josef-Hospital Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Samira Murad
- St. Josef-Hospital Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Guido Lewik
- St. Josef-Hospital Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Tobias Schulte
- St. Josef-Hospital Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
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Bari S, Menon V, Bhuvanesh S. Oral pharmacological management of Bertolotti syndrome presenting as chronic low back pain - A case report and review of literature. J Orthop 2025; 62:122-125. [PMID: 39524686 PMCID: PMC11543497 DOI: 10.1016/j.jor.2024.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 10/18/2024] [Indexed: 11/16/2024] Open
Abstract
Background Bertolotti syndrome (BS) is often a missed cause of chronic lower back pain in young individuals, commonly associated with the presence of anomalous lumbosacral transitional vertebrae. Case presentation A 19-year-old female with no significant medical or family history presented with persistent lower back pain localized to the gluteal region and posterolateral aspect of the left lower back. The pain worsened over time and limited their movements, including walking. A Ferguson radiograph revealed fusion of the left transverse process of the L5 vertebral segment with the left sacral ala. History, examination findings, and radiological workup confirmed the diagnosis of BS. The patient preferred conservative management, receiving oral pharmacological therapy for six weeks, along with education on preventive measures and routine exercises for postural stability. At a six-month follow-up, the patient remained asymptomatic and managed well. Conclusions Conservative oral pharmacological treatment presents a unique and viable alternative to traditional methods for managing BS, which often involve surgery or steroids/anesthetics at the pseudo-articulation site. Given that BS is common yet underdiagnosed in young patients with chronic back pain, this report also underscores the importance of including it in differential diagnoses for chronic lower back pain in this demographic.
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Affiliation(s)
- Saarim Bari
- School of Medicine, University of Central Lancashire, Preston, PR1 7BH, United Kingdom
- Cumberland Infirmary, North Cumbria Integrated Care, Carlisle CA2 7HY, United Kingdom
| | - Varun Menon
- School of Medicine, University of Central Lancashire, Preston, PR1 7BH, United Kingdom
- Cumberland Infirmary, North Cumbria Integrated Care, Carlisle CA2 7HY, United Kingdom
| | - Shankar Bhuvanesh
- School of Medicine, University of Central Lancashire, Preston, PR1 7BH, United Kingdom
- Cumberland Infirmary, North Cumbria Integrated Care, Carlisle CA2 7HY, United Kingdom
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Berg JA, Saevik BK, Lingaas F, Trangerud C. Transitional lumbosacral vertebrae in black Norwegian elkhound and Brittany dogs: Clinical findings and its association with degenerative lumbosacral stenosis. Acta Vet Scand 2025; 67:10. [PMID: 39939978 PMCID: PMC11816518 DOI: 10.1186/s13028-025-00797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 01/31/2025] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND Lumbosacral transitional vertebra (LTV) is a congenital anomaly in dogs and have been proposed to be associated with cauda equina syndrome (CES) in German Shepherd dogs. This prospective study, including 32 dogs from two breeds, aims to investigate if LTV is associated with lower back pain in dogs. The study compared owners' assessment of their dogs' well-being and clinical evaluation with advanced diagnostic imaging to identify changes that might explain clinical findings. RESULTS Dogs with LTV type 2 (57.0%) and with LTV type 3 (70.0%) exhibited mild lower back pain, which was significantly more frequent (P = 0.012) compared to dogs with LTV type 0 and LTV type 1. Advanced diagnostic imaging identified a plausible cause for this pain. Dogs diagnosed with LTV types 2 and 3 with lower back pain tended to be lighter (median 14.50 kg) and younger (median 4.10 years) than breeds typically reported for degenerative lumbosacral stenosis (DLSS). Based on the owners' assessment of their dogs, they considered them pain-free. CONCLUSIONS The study identified a correlation between LTV types 2 and 3 and lower back pain in these dog breeds. Advanced diagnostic imaging findings confirmed that dogs with these LTV types were more likely to exhibit pathological changes associated with DLSS.
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Affiliation(s)
- Jon Andre Berg
- Department of Preclinical Sciences and Pathology, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oluf Thesens Vei 30, Ås, 1432, Norway.
- AniCura Jeløy Dyresykehus, Varnaveien 43d, Moss, 1526, Norway.
| | | | - Frode Lingaas
- Department of Preclinical Sciences and Pathology, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oluf Thesens Vei 30, Ås, 1432, Norway
| | - Cathrine Trangerud
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oluf Thesens Vei 30, Ås, Norway
- Veterinaerradiologene AS, Skytta terrasse 2, Hagan, 1481, Norway
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Kapetanakis S, Gkoumousian K, Gkantsinikoudis N, Chaniotakis C. Functional outcomes of microdiscectomy in Bertolotti syndrome: the relationship between lumbosacral transitional vertebrae and lumbar disc herniation: a prospective study in Greece. Asian Spine J 2025; 19:94-101. [PMID: 40037323 PMCID: PMC11895107 DOI: 10.31616/asj.2024.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 10/23/2024] [Accepted: 11/20/2024] [Indexed: 03/06/2025] Open
Abstract
STUDY DESIGN The lumbosacral transitional vertebrae (LSTV) in patients with Bertolotti syndrome (BS) cause alterations in the biomechanics of the lumbosacral junction. These entities have been associated with secondary conditions, such as lumbar disc herniation (LDH). PURPOSE To investigate the clinical outcomes of microdiscectomy in patients with symptomatic LDH and BS. OVERVIEW OF LITERATURE There is limited data in the literature on the functional outcomes of patients with LSTV who undergo microdiscectomy. METHODS This study enrolled 308 patients diagnosed with LDH and concurrent LSTV. All patients underwent microdiscectomy. Clinical evaluation was performed preoperatively and at distinct follow-up intervals of 1, 3, 6, and 12 months, and 2 and 5 years postoperatively. Assessment included clinical examination and implementation of the well-established, patient-reported outcome measures Visual Analog Scale (VAS) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire for Health-Related Quality of Life (HRQoL) analysis. Furthermore, the anatomical relationship between LSTV and LDH was also studied. RESULTS The SF-36 indices and VAS score were statistically significantly ameliorated within the follow-up period. Maximum improvement was noted at 3 months, with further minimal improvement after 6 months, and stabilization of indices until the end of followup. Castellvi type IB was the most frequent LSTV type. The adjacent level (L4-L5) just above the LSTV was the most affected with an incidence of 72.1%. In the subgroups of Castellvi type IA, IIA, and IIIA, the LDH side was ipsilateral with the LSTV in 38.3% of patients. In this study, all patients underwent microdiscectomy and demonstrated favorable clinical outcomes (functional recovery and pain relief) and notable amelioration of HRQoL. CONCLUSIONS To the best of our knowledge, this is the first study to conduct a holistic assessment in an attempt to delineate the impact of LSTV presence on the postoperative HRQoL of these individuals.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki,
Greece
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens,
Greece
| | - Krikor Gkoumousian
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki,
Greece
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Rakauskas TR, Gallup S, Mohamed AA, Nasice J, Westerhaus B. An update on the prevalence and management of Bertolotti's syndrome. Front Surg 2024; 11:1486811. [PMID: 39726766 PMCID: PMC11669649 DOI: 10.3389/fsurg.2024.1486811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 11/27/2024] [Indexed: 12/28/2024] Open
Abstract
Bertolotti's Syndrome, a subset of lumbosacral transitional vertebrae (LSTV), is one cause of chronic low back pain (LBP), and a commonly overlooked differential diagnosis. The incidence of Bertolotti's Syndrome has been underestimated in the past and is common in those of younger ages around 30-40. Although diagnostics, imaging methods, and treatment algorithms have been improved in the past few years, there is no gold standard and more long-term, prospective research is needed. The purpose of this mini-review is to increase awareness of Bertolotti's Syndrome, discuss recent advancements in treatment algorithms, and highlight current gaps in the literature.
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Affiliation(s)
- Taylor R. Rakauskas
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Shannon Gallup
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Ali A. Mohamed
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Jude Nasice
- Cantor Spine Center at the Paley Institute, West Palm Beach, FL, United States
| | - Benjamin Westerhaus
- Cantor Spine Center at the Paley Institute, West Palm Beach, FL, United States
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Ju CI, Kim P, Seo JH. Full-Endoscopic J-Shaped Transforaminal L5 Nerve Decompression in Bertolotti Syndrome. Neurospine 2024; 21:1131-1136. [PMID: 39765255 PMCID: PMC11744531 DOI: 10.14245/ns.2449112.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 11/11/2024] [Accepted: 11/19/2024] [Indexed: 01/23/2025] Open
Abstract
This case report and video demonstrate the technique of full-endoscopic J-shaped transforaminal L5 exiting nerve decompression in Bertolotti syndrome. Bertolotti syndrome, characterized by a congenital lumbosacral transitional vertebra, often results in mechanical lower back pain and nerve root compression. A 69-year-old male presented with progressive radiating pain in the right leg and tingling in the L5 dermatome. Lumbar spine MRI revealed a right foraminal disc herniation at the L5-S1 level, with calcification and foraminal stenosis. The patient was also diagnosed with Castellvi type I Bertolotti syndrome, featuring a large L5 transverse process and a high iliac crest. These anatomical variations complicated the transforaminal approach, creating a narrow safety zone for conventional methods. The approach began with docking on the L5 transverse process. Endoscopic drilling was performed in a J-shaped configuration to partially resect the transverse process and alar wing, facilitating endoscope insertion into Kambin's triangle. Foraminal decompression was achieved by removing the tip of the superior articular process (SAP), thereby decompressing the L5 exiting nerve root. Full-endoscopic spine surgery offers a safe and effective alternative to traditional open techniques for L5 nerve decompression in Bertolotti syndrome. This video presentation illustrates the intraoperative endoscopic approach, detailing the decompression techniques and highlighting the minimally invasive advantages of this method.
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Affiliation(s)
- Chang-Il Ju
- Department of Neurosurgery, Chosun University Hospital, Gwangju, Korea
| | - Pius Kim
- Department of Neurosurgery, Chosun University Hospital, Gwangju, Korea
| | - Jong Hun Seo
- Department of Neurosurgery, Chosun University Hospital, Gwangju, Korea
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Jaghab A, Yearsley A, Raghunandan A. A Hunt for the Etiology of Lumbar Radiculopathy: A Clinical Vignette. Am J Phys Med Rehabil 2024; 103:e178-e181. [PMID: 38709656 DOI: 10.1097/phm.0000000000002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Annmarie Jaghab
- From the Department of Physical Medicine and Rehabilitation, University Texas Health San Antonio, San Antonio, Texas
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Hanhivaara J, Määttä JH, Kinnunen P, Niinimäki J, Nevalainen MT. Castellvi classification of lumbosacral transitional vertebrae: comparison between conventional radiography, CT, and MRI. Acta Radiol 2024; 65:1515-1520. [PMID: 39444351 DOI: 10.1177/02841851241289355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
BACKGROUND The reliability and diagnostic accuracy of commonly used diagnostic imaging modalities in the classification of lumbosacral transitional vertebrae (LSTV) are poorly known, and comparative studies are scarce. PURPOSE To compare the diagnostic performance of conventional radiography (CR), computed tomography (CT), and magnetic resonance imaging (MRI) in classifying LSTVs. MATERIAL AND METHODS In this retrospective cross-sectional study, a total of 852 patients undergoing lumbar imaging studies using all three modalities were initially assessed for the presence of LSTV using CT scans. In total, 100 patients with LSTV anatomy were identified. Four readers performed blinded and independent evaluations of these 100 patients on each modality, and an experienced fellowship-trained radiologist performed a gold standard read using all three modalities. Inter-reader reliability metrics were analyzed in comparison to the gold standard. Statistical software R (4.2.1) was used for the analyses. RESULTS We found superior diagnostic efficacy for CT: the sensitivity, specificity, accuracy, and balanced accuracy were 76%, 93%, 77%, and 84%, respectively. For MRI, the metrics were 54%, 88%, 56%, and 68%, and for CR 32%, 85%, 42%, and 59%, respectively. Inter-reader reliability was found to be good for CT (κ = 0.63-0.71) and fair for both CR (κ = 0.16-0.32) and MRI (κ = 0.24-0.56). CONCLUSION CT had the highest diagnostic performance in all measured metrics with good inter-reader reliability. MRI and CR showed fairly poor sensitivity and accuracy, and thus consideration should be used when classifying LSTVs with these two modalities.
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Affiliation(s)
- Jaakko Hanhivaara
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Juhani H Määttä
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Pietari Kinnunen
- Department of Orthopedic Surgery, Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
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Cho S, Ahn YJ, Lee YJ, Ha IH, Lee YS. Integrative Korean medicine treatment for low back pain with radiculopathy caused by Bertolotti syndrome: A CARE-compliant article and retrospective review of medical records. Medicine (Baltimore) 2024; 103:e39720. [PMID: 39287242 PMCID: PMC11404960 DOI: 10.1097/md.0000000000039720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/09/2024] [Accepted: 08/26/2024] [Indexed: 09/19/2024] Open
Abstract
RATIONALE Bertolotti syndrome (BS) is characterized by radiculopathy caused by structural anomalies. Despite the structural deformity, conservative treatment is predominantly recommended due to surgery-related complications. Because of the diagnosis complexity, the incidence and contributing factors of BS, remain controversial. We report the case of a patient with BS who was treated with integrative Korean medicine (IKM). Moreover, we evaluated the epidemiological characteristics of lumbosacral transitional vertebrae (LSTV) from medical records of patients diagnosed with LSTV at 4 different medical clinics of Korean medicine. PATIENT CONCERNS A 33-year-old male patient with low back pain and severe radiculopathy was diagnosed with BS (Castellvi Type II) on magnetic resonance imaging at a local orthopedic clinic. Additionally, the medical records of patients with BS who had been treated with IKM in 4 different institutions of Korean medicine were analyzed, and the characteristics of patients suffering from BS were identified. DIAGNOSES, INTERVENTIONS, AND OUTCOMES The patient underwent IKM treatment for 40 days as an inpatient. The patient's condition was assessed using the Euroqol 5-dimension index and Oswestry Disability Index, and symptom severity was measured using the Numeric Rating Scale. IKM was effective in improving pain and functional disability without causing any adverse effects. In a retrospective review of medical records, the study identified symptom trends reported by patients with LSTV. LESSONS IKM demonstrates potential efficacy in BS management, with notable trends in LSTV-related symptomatology warranting further investigation.
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Affiliation(s)
- Sohyun Cho
- Jaseng Korean Medicine Hospital, Seoul, Korea
| | | | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
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Bhagchandani C, Murugan C, Jakkepally S, Shetty AP, Kanna RM, Rajasekaran S. A Whole Spine MRI Based Study of the Prevalence, Associated Disc Degeneration and Anatomical Correlations of Lumbosacral Transitional Vertebra. Global Spine J 2024; 14:1952-1958. [PMID: 36867110 PMCID: PMC11418674 DOI: 10.1177/21925682231161559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Lumbosacral transitional vertebra (LSTV) results in numerical alterations of the lumbar and sacral segments. Literature concerning true prevalence, associated disc degeneration, and variation in numerous anatomical landmarks concerning LSTV is lacking. METHODS This is a retrospective cohort study. The prevalence of LSTV was determined in whole spine MRIs of 2011 poly-trauma patients. LSTV was identified as sacralization (LSTV-S) or lumbarization (LSTV-L) and further sub-classified into Castellvi's and O'Driscoll's type respectively. Disc degeneration was evaluated using Pfirmann grading. Variation in important anatomical landmarks was also analysed. RESULTS Prevalence of LSTV was 11.6% with 82% having LSTV-S. Castellvi's type 2A and O'Driscoll type 4 were the commonest sub-types. LSTV patients demonstrated considerably advanced disc degeneration. The median termination level of conus medullaris (TLCM) in non- LSTV and LSTV-L groups was at middle L1 (48.1% and 40.2%) while in the LSTV-S group, it was at upper L1 (47.2%). The median level of right renal artery (RRA) in non- LSTV patients was at middle L1 in 40.0% of individuals while in the LSTV-L and LSTV-S groups, it was at upper L1 level in 35.2% and 56.2% respectively. The median level of abdominal aortic bifurcation (AA) in non-LSTV and LSTV-S patients was at middle L4 in 83.3% and 52.04% respectively. However, in the LSTV-L group, the most common level was middle L5 (53.6%). CONCLUSION The overall prevalence of LSTV was 11.6%, with sacralization accounting for more than 80%. LSTV is associated with disc degeneration and a variation in the levels of important anatomical landmarks.
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Affiliation(s)
| | - Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
| | - Sridhar Jakkepally
- Department of Spine Surgery, Gandhi Medical College and Hospital, Secunderabad, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India
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Desai A, Obiri-Yeboah D, McGrath K, Sheehan J, Loss J, Reith JD, Steinmetz MP. Histologic Assessment of Lumbosacral Transitional Vertebrae Pseudoarticulation as a Source of Pain in Bertolotti Syndrome. World Neurosurg 2024; 189:e267-e271. [PMID: 38878893 DOI: 10.1016/j.wneu.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Bertolotti syndrome (BS) is characterized by chronic pain and functional impairment associated with lumbosacral transitional vertebrae (LSTVs). The study aimed to investigate the histologic characteristics of the pseudoarticulation between the enlarged transverse process and sacrum seen in Castellvi 2a LSTV and explore the involvement of nervous tissue in pain generation. METHODS Immunohistochemical analysis using S100 protein staining was performed to assess the presence of nerve tissue. RESULTS These changes included fibrillation, chondrocyte cloning, alterations in the proteoglycan matrix, and focal chondrocyte necrosis. Notably, no nerve tissue was observed in any of the specimens, as confirmed by negative S100 protein staining. CONCLUSIONS The study findings suggest that nerve tissue is not involved in the nociceptive mechanisms underlying pain in BS. The histologic similarities between the pseudoarticulation and osteoarthritic joints indicate that pseudoarticulation itself may be a significant source of pain in BS. These insights contribute to our understanding of the pathophysiology of BS and support treatment paradigms prioritizing pain control with medications such as NSAIDs before considering surgical intervention. Future studies with larger sample sizes and in vivo models are needed to further validate these findings and explore the changes in joint histology under biomechanical forces in LSTVs.
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Affiliation(s)
- Ansh Desai
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Derrick Obiri-Yeboah
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kyle McGrath
- University of Cincinnati Medical Center, Department of Neurosurgery, Cincinnati, Ohio, USA
| | - Jamie Sheehan
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeremy Loss
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John D Reith
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael P Steinmetz
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Rädel B, James Paton G. The Clinical Significance of Lumbar Transverse Process Lengths Associated with Lumbosacral Transitional Vertebrae: A Landmark for Lumbar Spine Enumeration. World Neurosurg 2024; 189:e108-e118. [PMID: 38843967 DOI: 10.1016/j.wneu.2024.05.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE This study aimed to identify which lumbar vertebral level above a lumbosacral transitional vertebra (LSTV) demonstrated the longest transverse process (TVP) lengths. METHODS In this exploratory quantitative osteological cohort study using a digital Vernier caliper, dried human cadaveric lumbar TVPs were measured for linear horizontal length at each lumbar vertebra, left and right sides. Data collection was conducted in South Africa at the Raymond A. Dart Collection of Modern Human Skeletons and the Pretoria Bone Collection. The LSTV cohort consisted of 110 spinal columns and an LSTV-free control cohort of a sex-balanced randomized selection of 30 male and 30 female spinal columns. RESULTS Compared with the control cohort, the LSTV cohort demonstrated longer TVPs for every vertebral level, particularly L3, while the left side demonstrated longer TVPs overall. There were no statistical differences in TVP length within the LSTV cohort when comparing all levels (P > 0.05). The L3 TVPs demonstrated the longest mean lengths in both control (65%) and LSTV (58%) cohorts. The general trend was that the TVPs of L3 had the longest mean length for both the left and the right sides in both cohorts and both sexes. CONCLUSIONS In the absence of whole-spine imaging, these findings indicate that L3 TVPs may offer an alternative bony landmark, which may aid in spinal enumeration estimation in the setting of LSTV. This is of value for radiograph appraisal and may aid with correct-level intervention.
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Affiliation(s)
- Bianca Rädel
- Faculty of Health Sciences, Department of Chiropractic, University of Johannesburg, Johannesburg, South Africa
| | - Glen James Paton
- Faculty of Health Sciences, Department of Chiropractic, University of Johannesburg, Johannesburg, South Africa.
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Oh J, Kim B, Oh G, Hwangbo Y, Ye JC. End-to-End Semi-Supervised Opportunistic Osteoporosis Screening Using Computed Tomography. Endocrinol Metab (Seoul) 2024; 39:500-510. [PMID: 38721637 PMCID: PMC11220219 DOI: 10.3803/enm.2023.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGRUOUND Osteoporosis is the most common metabolic bone disease and can cause fragility fractures. Despite this, screening utilization rates for osteoporosis remain low among populations at risk. Automated bone mineral density (BMD) estimation using computed tomography (CT) can help bridge this gap and serve as an alternative screening method to dual-energy X-ray absorptiometry (DXA). METHODS The feasibility of an opportunistic and population agnostic screening method for osteoporosis using abdominal CT scans without bone densitometry phantom-based calibration was investigated in this retrospective study. A total of 268 abdominal CT-DXA pairs and 99 abdominal CT studies without DXA scores were obtained from an oncology specialty clinic in the Republic of Korea. The center axial CT slices from the L1, L2, L3, and L4 lumbar vertebrae were annotated with the CT slice level and spine segmentation labels for each subject. Deep learning models were trained to localize the center axial slice from the CT scan of the torso, segment the vertebral bone, and estimate BMD for the top four lumbar vertebrae. RESULTS Automated vertebra-level DXA measurements showed a mean absolute error (MAE) of 0.079, Pearson's r of 0.852 (P<0.001), and R2 of 0.714. Subject-level predictions on the held-out test set had a MAE of 0.066, Pearson's r of 0.907 (P<0.001), and R2 of 0.781. CONCLUSION CT scans collected during routine examinations without bone densitometry calibration can be used to generate DXA BMD predictions.
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Affiliation(s)
- Jieun Oh
- Healthcare AI Team, National Cancer Center, Goyang, Korea
| | - Boah Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Gyutaek Oh
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, Goyang, Korea
| | - Jong Chul Ye
- Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
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Covasa CT. Transitional, fused and/or supernumerary vertebrae in the lumbosacrocaudal region of the spine - A reality in many domestic mammals. VET MED-CZECH 2024; 69:156-168. [PMID: 38841130 PMCID: PMC11148713 DOI: 10.17221/102/2023-vetmed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/28/2024] [Indexed: 06/07/2024] Open
Abstract
The aim of this study was to identify the presence of transitional lumbosacral and sacrocaudal vertebrae in domestic mammals, to realise a comparative analysis of the localisation and conformation of this abnormal condition. The research included the following species: cattle - 29 specimens, sheep - 32 specimens, horse - 31 specimens, pig - 26 specimens, rabbit - 33 specimens, dog - 89 specimens and cat - 57 specimens. The spine of the animals was analysed post-mortem or radiologically. The investigations revealed the presence of transitional vertebrae as follows: in cattle - 3 cases (8.7%), all being about the lumbarisation of the first sacral vertebra (S1); in sheep - 3 cases (9.37%), two lumbarisation cases of S1 and one caudalisation of S4 (the last sacral vertebra); in horses - 4 cases (12.9%), all about the sacralisation of Cd1 (first caudal vertebra); in pigs - 3 cases (11.53%), two lumbarisation cases of S1 and one sacralisation of Cd1; in rabbits - 3 cases (9.09%), a lumbar supernumerary vertebra (L8) and two cases of caudalisation of S4; in dogs - 4 cases (4.49%), a lumbar supernumerary vertebra (L8) and 3 cases of sacralisation of the last lumbar vertebra (L7 or L8); in cats - 3 cases (5.26%), two sacralisation cases of the last lumbar vertebra and one case of caudalisation of the last sacral vertebra (S3). A strong lumbarisation process was observed in ruminants (especially in cattle), then in pigs, the sacralisation being prevalent in carnivores. The sacrocaudal transitional vertebra was predominant in horses. No evident influence of the sex and age of the animals was observed.
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Affiliation(s)
- Costica Toader Covasa
- Department of Preclinics, Faculty of Veterinary Medicine, University of Life Sciences, Iasi, Romania
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15
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Bhagchandani C, Murugan C, Arumugam T, Karuppanan Sukumaran SVA, Shetty AP, Kanna RM, Rajasekaran S. A Whole-Spine Magnetic Resonance Imaging-Based Cross-Sectional Study of the Clinicoradiological Association of Lumbosacral Transitional Vertebra with Degenerative Disc Disease, End Plate Degeneration, Low Back Pain, and Facet Tropism. World Neurosurg 2024; 185:e1121-e1128. [PMID: 38492662 DOI: 10.1016/j.wneu.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To understand lumbosacral transitional vertebra (LSTV)-associated degenerative pathologies and their correlation to low back pain and radicular pain. METHODS Whole-spine magnetic resonance imaging was evaluated for disc degeneration using Pfirrmann grading, end plate changes using total end plate score (TEPS), and facet tropism in patients with low back pain and radicular pain, and their association with LSTV was analyzed. RESULTS In group 1, LSTV was seen in 15% of patients with 83% of these patients having sacralization. Disc degeneration was seen in 58%, 51%, and 63% of patients at levels C, B, and A, respectively; patients with sacralization had significant degeneration at all 3 levels. Similarly, the total end plate score and facet tropism were significantly higher in patients with sacralization. Facet tropism was observed in 31%, 40%, and 35% of patients with no -LSTV, patients with sacralization, and patients with lumbarization, respectively. In group 2, LSTV was seen in 17% of patients with sacralization accounting for 82%. Disc degeneration was seen in 44%, 36%, and 54% patients at levels C, B, and A, respectively. No significant difference was observed in the mean total end plate score between groups. Facet tropism was identified in 89% and 81% of patients with sacralization and patients with lumbarization, respectively, compared with only 19% of patients with no LSTV. CONCLUSIONS Patients with low back pain had a higher incidence of sacralization with corresponding disc degeneration, facet tropism ,and end plate changes. In patients with radicular pain, lumbarization was associated only with facet tropism. These findings may aid clinicians in prognostication and patient counseling.
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Affiliation(s)
| | - Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Thirumurugan Arumugam
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | | | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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16
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Abul K. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome. Int J Spine Surg 2024; 18:81-82. [PMID: 38320805 PMCID: PMC11265503 DOI: 10.14444/8571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Kadir Abul
- Department of Orthopedics and Traumatology, Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey
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17
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Vu PD, Robinson CL, Viswanath O, Urits I, Hasoon J. Techniques in medicine: ipsilateral transforaminal epidural steroid injection in Bertolotti's syndrome. Pain Manag 2024; 14:125-128. [PMID: 38385170 PMCID: PMC11412131 DOI: 10.2217/pmt-2023-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Bertolotti's syndrome, also known as lumbosacral transitional vertebrae, is a relatively rare spinal condition characterized by an anatomical variation in the lower spine. Conservative approaches such as physical therapy, anti-inflammatory medications and lifestyle modifications may be recommended for mild cases. In more severe cases or when conservative measures fail to provide relief, injections such as may be considered to alleviate pain. This case is unique in that we document a challenging technique of ipsilateral transforaminal epidural steroid injection in a patient with Bertolotti's syndrome.
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Affiliation(s)
- Peter D Vu
- UTHealth McGovern Medical School, Department of Physical Medicine & Rehabilitation, Houston, TX77030, USA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, & Pain Medicine, Harvard Medical School, Boston, MA02215, USA
| | - Omar Viswanath
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA71103, USA
| | - Ivan Urits
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA71103, USA
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesia & Pain Medicine, Houston, TX77030, USA
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18
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Chai Y, Maes V, Boudali AM, Rackel B, Walter WL. Inadequate Annotation and Its Impact on Pelvic Tilt Measurement in Clinical Practice. J Clin Med 2024; 13:1394. [PMID: 38592694 PMCID: PMC10931960 DOI: 10.3390/jcm13051394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Accurate pre-surgical templating of the pelvic tilt (PT) angle is essential for hip and spine surgeries, yet the reliability of PT annotations is often compromised by human error, inherent subjectivity, and variations in radiographic quality. This study aims to identify challenges leading to inadequate annotations at a landmark dimension and evaluating their impact on PT. METHODS We retrospectively collected 115 consecutive sagittal radiographs for the measurement of PT based on two definitions: the anterior pelvic plane and a line connecting the femoral head's centre to the sacral plate's midpoint. Five annotators engaged in the measurement, followed by a secondary review to assess the adequacy of the annotations across all the annotators. RESULTS The outcomes indicated that over 60% images had at least one landmark considered inadequate by the majority of the reviewers, with poor image quality, outliers, and unrecognized anomalies being the primary causes. Such inadequacies led to discrepancies in the PT measurements, ranging from -2° to 2°. CONCLUSION This study highlights that landmarks annotated from clear anatomical references were more reliable than those estimated. It also underscores the prevalence of suboptimal annotations in PT measurements, which extends beyond the scope of traditional statistical analysis and could result in significant deviations in individual cases, potentially impacting clinical outcomes.
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Affiliation(s)
- Yuan Chai
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, Sydney, NSW 2006, Australia; (A.M.B.); (W.L.W.)
| | - Vincent Maes
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia;
| | - A. Mounir Boudali
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, Sydney, NSW 2006, Australia; (A.M.B.); (W.L.W.)
| | - Brooke Rackel
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia;
| | - William L. Walter
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, Sydney, NSW 2006, Australia; (A.M.B.); (W.L.W.)
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia;
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19
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Kim JK, Chang MC, Park WT, Lee GW. Identification of L5 vertebra on lumbar spine radiographs using deep learning. J Int Med Res 2024; 52:3000605231223881. [PMID: 38206194 PMCID: PMC10785730 DOI: 10.1177/03000605231223881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Deep learning is an advanced machine-learning approach that is used in several medical fields. Here, we developed a deep learning model using an object detection algorithm to identify the L5 vertebra on anteroposterior lumbar spine radiographs, and assessed its detection accuracy. METHODS We retrospectively recruited 150 participants for whom both anteroposterior whole-spine and lumbar spine radiographs were available. The anteroposterior lumbar spine radiographs of these patients were used as the input data. Of the 150 images, 105 (70%) were randomly selected as the training set, and the remaining 45 (30%) were assigned to the validation set. YOLOv5x, of the YOLOv5 family model, was used to detect the L5 vertebra area. RESULTS The mean average precisions 0.5 and 0.75 of the trained L5 detection model were 99.2% and 96.9%, respectively. The model's precision was 95.7% and its recall was 97.8%. Furthermore, 93.3% of the validation data were correctly detected. CONCLUSION Our deep learning model showed an outstanding ability to identify L5 vertebrae.
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Affiliation(s)
- Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Wook Tae Park
- Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Gun Woo Lee
- Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea
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20
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Ali M, Enchev Y. A rare cause of low back pain in adolescence - Bertolotti syndrome: A case report. Surg Neurol Int 2023; 14:383. [PMID: 37941609 PMCID: PMC10629326 DOI: 10.25259/sni_762_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
Background Bertolotti syndrome (BS) is defined as a congenital anomaly of the spine that includes sacralization of the lowest lumbar vertebra or lumbarization of the first sacral vertebra (i.e., lumbosacral transitional vertebra- LSTV) and the pain associated with this condition. The incidence of BS in adolescence is rare; we found only three such case reports of patients under the age of 18 in the literature, here will add a fourth. Case Description A 17-year-old female presented with a 2-month history of low back pain exacerbated by physical activity. Her neurological examination was normal, except for pain elicited when applying pressure over the sacroiliac joints bilaterally, and over the spinous process of the L5 vertebra. The computed tomography scan documented BS: (i.e., LSTV - Castellvi classification: Type IIa on the left side). She was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone. Conclusion Here, we report a 17-year-old female who was symptomatic from BS and was successfully treated with NSAIDs.
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Affiliation(s)
- Mustafa Ali
- Department of Neurosurgery and Ear, Nose and Throat Diseases, Division of Neurosurgery, Medical University of Varna, Varna, Bulgaria
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21
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Sencan S, Azizov S, Celenlioglu AE, Bilim S, Gunduz OH. Effect of sacralization on the success of lumbar transforaminal epidural steroid injection treatment: prospective clinical trial. Skeletal Radiol 2023; 52:1949-1957. [PMID: 35705827 DOI: 10.1007/s00256-022-04089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to invastigate the effect of the sacralization on the results of transforaminal epidural steroid injection for radicular low back pain. MATERIALS AND METHODS The study included 64 patients diagnosed with radicular low back pain due to unilateral and single-level lumbar disk herniation. Patients were divided into 2 groups: patients with sacralization (Group S) and patients without lumbosacral transitional vertebrae (Group A). Injection was applied to the relevant level. Patients were evaluated with Numeric Rating Scale and Modified Oswestry Disability Index before, at week 3 and month 3 after the procedure. Sacralization presence was determined by MRI. Sacralization was categorized by anteroposterior lumbar radiography using Castellvi classification. Treatment success was considered as ≥ 50% reduction in NRS scores. RESULTS Numeric Rating Scale and Modified Oswestry Disability Index scores decreased in both groups on both week 3 and month 3 (p < 0.05). Pain scores of Group S (median value 5 (3-6)) were significantly higher than Group A ((median value 3 (0-5)) in the third month follow-up (p = 0.026), but no significant difference was observed at other time points. There was no significant difference in Modified Oswestry Disability Index scores between the groups at all follow-ups (p > 0.05). Treatment success in the third month was 44.8% in Group S and 65.6% in Group A. CONCLUSION Transforaminal epidural steroid injection is an effective and safe method for radicular low back pain. Sacralization presence should be evaluated before treatment considering that it may be a risk factor reducing treatment success.
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Affiliation(s)
- Savas Sencan
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca, Fevzi Çakmak, Mahallesi, Pendik, Istanbul, 34906, Turkey
| | - Sahin Azizov
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca, Fevzi Çakmak, Mahallesi, Pendik, Istanbul, 34906, Turkey
| | - Alp Eren Celenlioglu
- Department of Pain Medicine, University of Health Sciences Gulhane Training and Research Hospital, General Dr.Tevfik Sağlam Cd. No:1, Etlik, Ankara, 06010, Turkey.
| | - Serhad Bilim
- Department of Pain Medicine, Adıyaman University Training and Research Hospital, Ziyaretpayamlı/Adıyaman, Merkez/Adıyaman, Turkey
| | - Osman Hakan Gunduz
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca, Fevzi Çakmak, Mahallesi, Pendik, Istanbul, 34906, Turkey
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22
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Balza R, Palmer WE. Symptom-imaging correlation in lumbar spine pain. Skeletal Radiol 2023; 52:1901-1909. [PMID: 36862178 DOI: 10.1007/s00256-023-04305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Abstract
Lumbar spine MRI is associated with a high prevalence of morphological abnormalities in both symptomatic and asymptomatic individuals. A difficult challenge, therefore, is distinguishing the relevant findings causing symptoms from incidental findings. The accurate diagnosis of pain generator is important because misdiagnosis can negatively impact patient management and outcome. Spine physicians use clinical symptoms and signs to interpret lumbar spine MRI and make treatment decisions. Symptom-MRI correlation enables the targeted inspection of images for pain generator. Radiologists can also use clinical information to improve diagnostic confidence and the value of dictated reports. Because high-quality clinical information may be difficult to obtain, radiologists often generate lists of lumbar spine abnormalities that are otherwise difficult to rank as pain generators. Based on the literature review, this article attempts to distinguish the MRI abnormalities that may represent incidental findings from the abnormalities that are more commonly associated with lumbar spine-related symptoms.
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Affiliation(s)
- Rene Balza
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, YAW 6030, Boston, MA, 02114, USA.
| | - William E Palmer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, YAW 6030, Boston, MA, 02114, USA
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23
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Jenkins AL, O'Donnell J, Chung RJ, Jenkins S, Hawks C, Lazarus D, McCaffrey T, Terai H, Harvie C. Redefining the Classification for Bertolotti Syndrome: Anatomical Findings in Lumbosacral Transitional Vertebrae Guide Treatment Selection. World Neurosurg 2023; 175:e303-e313. [PMID: 36965661 DOI: 10.1016/j.wneu.2023.03.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE We present the Jenkins classification for Bertolotti syndrome or symptomatic lumbosacral transitional vertebra (LSTV) and compare this with the existing Castellvi classification for patients presenting for treatment. METHODS We performed a retrospective cohort study of 150 new patients presenting for treatment of back, hip, groin, and/or leg pain from July 2012 through February 2022. Using magnetic resonance imaging, computed tomography, and radiography, the patients with a radiographic finding of LSTV, an appropriate clinical presentation, and identification of LSTV as the primary pain generator via diagnostic injections were diagnosed with Bertolotti syndrome. Patients for whom conservative treatment had failed and who underwent surgery to address their LSTV were included in the present study. RESULTS The Castellvi classification excludes 2 types of anatomic variants: the prominent anatomic side and the potential transverse process and iliac crest contact. Of 150 patients with transitional anatomy, 103 (69%) were identified with Bertolotti syndrome using the Jenkins classification and received surgery (46 men [45%] and 57 women [55%]). Of the 103 patients, 90 (87%) underwent minimally invasive surgery. The patients presented with pain localized to the back (n = 101; 98%), leg (n = 79; 77%), hip (n = 51; 49%), and buttock (n = 52; 50%). Only 84 of the Jenkins classification patients (82%) met any of the Castellvi criteria. All 19 patients for whom the Castellvi classification failed had had type 1 anatomy using the Jenkins system and underwent surgery (decompression, n = 16 [84%]; fusion, n = 1 [5%]; fusion plus decompression, n = 2 [11%]). Of these 19 patients, 17 (89%) had improved pain scores. The 19 patients exclusively diagnosed via the Jenkins classification had no significant differences in improved pain compared with those diagnosed using the Castellvi classification. CONCLUSIONS The Jenkins classification improves on the prior Castellvi classification to more comprehensively describe the functional anatomy, identify uncaptured anatomy, and better predict optimal surgical procedures to treat those with Bertolotti syndrome.
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Affiliation(s)
- Arthur L Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Jenkins NeuroSpine, New York, New York, USA.
| | | | | | - Sarah Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Jenkins NeuroSpine, New York, New York, USA
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24
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Jenkins AL, Chung RJ, O'Donnell J, Hawks C, Jenkins S, Lazarus D, McCaffrey T, Terai H, Harvie C, Matsoukas S. Redefining the Treatment of Lumbosacral Transitional Vertebrae for Bertolotti Syndrome: Long-Term Outcomes Utilizing the Jenkins Classification to Determine Treatment. World Neurosurg 2023; 175:e21-e29. [PMID: 36898630 DOI: 10.1016/j.wneu.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Using the Jenkins classification, we propose a strategy of shaving down hypertrophic bone, unilateral fusion, or bilateral fusion procedures to achieve pain reduction and improve quality of life for patients with Bertolotti syndrome. METHODS We reviewed 103 patients from 2012 through 2021 who had surgically treated Bertolotti syndrome. We identified 56 patients with Bertolotti syndrome and at least 6 months of follow-up. Patients with iliac contact preoperatively were presumed to be more likely to have hip pain that could respond to surgical treatment, and those patients were tracked for those outcomes as well. RESULTS Type 1 patients (n = 13) underwent resection. Eleven (85%) had improvement, 7 (54%) had good outcome, 1 (7%) had subsequent surgery, 1 (7%) was suggested additional surgery, and 2 (14%) were lost to follow-up. In Type 2 patients (n = 36), 18 underwent decompressions and 18 underwent fusions as a first line. Of the 18 patients treated with resection an interim analysis saw 10 (55%) with failure and needing subsequent procedures. With subsequent procedure, 14 (78%) saw improvement. For fusion surgical patients, 16 (88%) saw some improvement and 13 (72%) had a good outcome. In Type 4 patients (n = 7), 6 (86%) did well with unilateral fusion, with durable benefit at 2 years. In patients who had hip pain preoperatively (n = 27), 21 (78%) had improvement of hip pain postoperatively. CONCLUSIONS The Jenkins classification system provides a strategy for patients with Bertolotti syndrome who fail conservative therapy. Patients with Type 1 anatomy respond well to resection procedures. Patients with Type 2 and Type 4 anatomy respond well to fusion procedures. These patients respond well in regard to hip pain.
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Affiliation(s)
- Arthur L Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Jenkins NeuroSpine, Private Practice, New York, New York, USA.
| | - Richard J Chung
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - John O'Donnell
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Charlotte Hawks
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Sarah Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | | | - Tara McCaffrey
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Hiromi Terai
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Camryn Harvie
- Jenkins NeuroSpine, Private Practice, New York, New York, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Becker L, Adl Amini D, Ziegeler K, Muellner M, Diekhoff T, Hughes AP, Pumberger M. Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5. Arch Orthop Trauma Surg 2023; 143:1753-1759. [PMID: 34999995 PMCID: PMC10030414 DOI: 10.1007/s00402-021-04303-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/08/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. MATERIAL AND METHODS We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. RESULTS Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. CONCLUSIONS For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dominik Adl Amini
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th S, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Delcont MR, Ou-Yang DC, Burger EL, Patel VV, Wessell NM, Kleck CJ. Alternative Uses of O-Arm and Stealth Navigation Technology Over 10 Years: The University of Colorado Experience. Orthopedics 2023; 46:e89-e97. [PMID: 35876781 DOI: 10.3928/01477447-20220719-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intraoperative computed tomography scanning with O-arm and use of Stealth navigation can improve surgical outcomes in a variety of orthopedic subspecialties. In spine surgery, the accuracy, precision, and safety of pedicle screw and interbody implant placement has improved. This technology is now routinely used in percutaneous pedicle screw placement and minimally invasive sacroiliac joint fusion. Other applications include, but are not limited to, isthmic pars defect repair, lumbosacral pseudoarticulation resection in Bertolotti's syndrome, radiofrequency ablation, and en bloc tumor resection. Intraoperative navigation has numerous applications, and use of this technology should continue to evolve as the technology advances. [Orthopedics. 2023;46(2):e89-e97.].
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Verhaegen JC, Alves Batista N, Horton I, Rakhra K, Beaulé PE, Michielsen J, Stratton A, Grammatopoulos G. Prevalence of Lumbosacral Transitional Vertebral Anomalies Among Healthy Volunteers and Patients with Hip Pathology: Association with Spinopelvic Characteristics. JB JS Open Access 2023; 8:e22.00095. [PMID: 37908325 PMCID: PMC10614646 DOI: 10.2106/jbjs.oa.22.00095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
A lumbosacral transitional vertebra (LSTV) has been reported to be prevalent among patients with hip dysplasia. The aims of this study were to determine the (1) prevalence of an LSTV in young patients presenting with hip pain and a group of asymptomatic volunteers, (2) effect of an LSTV on spinopelvic characteristics, and (3) presence of low back pain among patients with an LSTV. Methods This cross-sectional study included 102 patients with hip pathology and 51 asymptomatic volunteers (mean age, 33.9 ± 7.3 years; mean body mass index, 26.0 ± 5.0 kg/m2; 57.5% female). Participants underwent radiographic assessment of the lumbar spine and pelvis in standing and deep-seated positions. LSTV occurrence was classified according to the Castellvi system. Spinopelvic characteristics included lumbar lordosis (including segmental lumbar angles), pelvic tilt, and hip flexion (pelvic-femoral angle). Differences between standing and deep-seated values were calculated. Low back pain was assessed using the Oswestry Disability Index. Results The prevalence of LSTV type ≥II was 8.5%, with no difference between patients and volunteers (p = 0.386). Individuals with an LSTV had a greater standing L1-L5 angle (mean, 51.6° ± 11.7° versus 38.9° ± 9.3°; p < 0.001). The overall spinal flexion (change in L1-S1 angle between the standing and deep-seated positions) in individuals with an LSTV was similar to that in individuals without an LSTV; restricted L5-S1 mobility was compensated for at L1-L2 (10.2° ± 5.8° in those with versus 8.4° ± 4.1° in those without an LSTV; p = 0.070). No significant difference in the presence of low back pain was found (p = 0.250). Conclusions An LSTV was found in 8.5% of young adults, with no difference between patients with hip pathology and controls. Individuals with an LSTV have greater standing lumbar lordosis, with altered mechanics at the cephalad adjacent level, which may predispose these individuals to degenerative changes at this level. Level of Evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeroen C.F. Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- University Hospital Antwerp, Edegem, Belgium
| | - Nuno Alves Batista
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabel Horton
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kawan Rakhra
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E. Beaulé
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Alexandra Stratton
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Aliyev MA, Hozeev DV, Biryuchkov MY, Kundubayev RA, Riew KD. Prevalence of lumbosacral transitional vertebra among 4816 consecutive patients with low back pain: A computed tomography, magnetic resonance imaging, and plain radiographic study with novel classification schema. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:35-43. [PMID: 37213577 PMCID: PMC10198219 DOI: 10.4103/jcvjs.jcvjs_149_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/15/2023] [Indexed: 03/18/2023] Open
Abstract
Study Design A retrospective single-center study. Background The prevalence of the lumbosacral anomalies remains controversial. The existing classification to characterize these anomalies is more complex than necessary for clinical use. Purpose To assessment of the prevalence of lumbosacral transitional vertebra (LSTV) in patients with low back pain and the development of clinically relevant classification to describe these anomalies. Materials and Methods During the period from 2007 to 2017, all cases of LSTV were preoperatively verified, and classified according to Castellvi, as well as O'Driscoll. We then developed modifications of those classifications that are simpler, easier to remember, and clinically relevant. At the surgical level, this was assessed intervertebral disc and facet joint degeneration. Results The prevalence of the LSTV was 8.1% (389/4816). The most common L5 transverse process anomaly type was fused, unilaterally or bilaterally (48%), to the sacrum and were O'Driscoll's III (40.1%) and IV (35.8%). The most common type of S1-2 disc was a lumbarized disc (75.9%), where the disc's anterior-posterior diameter was equal to the L5-S1 disc diameter. In most cases, neurological compression symptoms (85.5%) were verified to be due to spinal stenosis (41.5%) or herniated disc (39.5%). In the majority of patients without neural compression, the clinical symptoms were due to mechanical back pain (58.8%). Conclusions LSTV is a fairly common pathology of the lumbosacral junction, occurring in 8.1% of the patients in our series (389 out of 4,816 cases). The most common types were Castellvi's type IIA (30.9%) and IIIA (34.9%) and were O'Driscoll's III (40.1%) and IV (35.8%).
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Affiliation(s)
- Vadim A. Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Andrei A. Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Valery V. Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | | | - Marat A. Aliyev
- Department of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Dmitriy V. Hozeev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Mikhail Y. Biryuchkov
- Department of Neurosurgery with Traumatology Course, West Kazakhstan Marat Ospanov Medical Unversity, Aktobe, Kazakhstan
| | - Rustem A. Kundubayev
- Department of Neurosurgery with Traumatology Course, West Kazakhstan Marat Ospanov Medical Unversity, Aktobe, Kazakhstan
| | - K. Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York City, New York, USA
- Department of Neurological Surgery, Weill Cornell Medical School, New York City, New York, USA
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Noorman MF, Sofian AA, Kandar MK, Ab Halim AH, Harun MH, Mohamed Ramlee FA, Che Hamzah F, Abdul Rahim E. Prevalence and severity of Bertolottis syndrome in Malaysia: A common under diagnosis. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:121-127. [PMID: 36606180 PMCID: PMC9809441 DOI: 10.51866/oa.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Bertolotti's syndrome (BS) is defined as the presence of low back pain (LBP), radiculopathy or both with a dysplastic transverse process (TP) of the fifth lumbar vertebra that is articulated or fused with the sacral base or iliac crest. This study aimed to investigate the prevalence and severity of BS to promote awareness of this disease. METHOD A retrospective review of anteroposterior lumbosacral plain radiographs was conducted between 1 January and 31 December 2017. Patients were recruited via systematic randomised sampling and were then interviewed and examined. The severity of BS was measured objectively using the numerical pain rating scale (NPRS) and Oswestry disability questionnaire (ODQ). Data were analysed using IBM SPSS for Windows version 22. RESULTS The prevalence of BS was 9.6% (16/166). Age significantly affected the severity of BS. The older and younger groups had a mean ODQ score of 42.86% and 24.08%, respectively (P=0.006). There was no significant relationship found between the prevalence of BS and age (P=0.126). Only one patient was diagnosed with BS during medical consultation. The mean NPRS score was 5.5. The majority of the BS cases were of moderate severity (43.8%), followed by those of minimal severity (31.2%) and severe disability (25%). CONCLUSION Early diagnosis of BS and orthopaedic referral are crucial to halt its progression. BS should be considered in patients presenting with LBP during assessments of lumbosacral radiographs.
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Affiliation(s)
- Mohamad Faiz Noorman
- MD (UKM), Master in Orthopaedic Surgery (UPM), Department of Orthopaedic, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Jalan Hospital, Sungai Buloh Campus, Selangor, Malaysia.
| | - Ahmad Anuar Sofian
- MBBS (CUCMS), Master in Orthopaedic Surgery (UPM), Department of Orthopaedic, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Jalan Hospital, Sungai Buloh Campus, Selangor, Malaysia
| | - Mohd Khairuddin Kandar
- MD (UKM), Master in Orthopaedic Surgery (UKM), Avisena Specialist Hospital, Jalan Ikhtisas, Seksyen 14, Shah Alam, Selangor, Malaysia
| | - Ashraf Hakim Ab Halim
- MD (UKM), Master in Orthopaedic Surgery (UKM), Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Hezery Harun
- (MD (USM), Doctor of Orthopaedic & Traumatology (UKM), Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Fadzrul Abbas Mohamed Ramlee
- MBBS (Ireland), Doctor of Orthopaedic & Traumatology (UKM), Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Fahrudin Che Hamzah
- MD (UKM), Master in Orthopaedic Surgery (UKM), Department of Orthopaedic, Faculty of Medicine and Health, Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ezamin Abdul Rahim
- MD (UKM), MMed (Radiology)(UKM), Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Fidan F, Balaban M, Hatipoğlu ŞC, Veizi E. Is lumbosacral transitional vertebra associated with lumbar disc herniation in patients with low back pain? 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 2022; 31:2907-2912. [PMID: 36063215 DOI: 10.1007/s00586-022-07372-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/29/2022] [Accepted: 08/27/2022] [Indexed: 05/21/2023]
Abstract
PURPOSE To evaluate lumbosacral transitional vertebrae (LSTV) frequency in patients with low back pain and lumbar disc herniation (LDH) and to analyze correlations between LSTV presence and intervertebral disc degeneration. METHODS This retrospective study included patients with low back pain applying between January 2021 and August 2021. Inclusion criteria were age of 18-65, presence of a standing lumbosacral Xray and a lumbar MRI taken within 2 weeks of the indexed symptoms. Patients with a history of spondylolisthesis, spondylodiscitis, scoliosis and vertebral neoplasia were excluded. A total of 1821 patients met the inclusion criteria. Radiographs and MRIs were evaluated by 2 radiologists. RESULTS Of all patients, 61.4% were female and the mean age was 43.2 ± 12.2. LDH was detected in 57.7% of patients while a LSTV was present in 43.3%. Sacralization and LSTV were significantly different between the patients with and without an LDH. Patients with LSTV had a higher incidence of a LDH affecting 3 or more intervertebral disc levels (p < 0.001). There was a significant difference in-between LSTV and non-LSTV groups regarding the M1 and M2 intervertebral disc degeneration levels. CONCLUSION A LDH is more common in the presence of a LSTV. Female sex is highly correlated with herniation. Three or more intervertebral disc levels are affected in the presence of an LSTV. Significantly higher degeneration incurs at the M1 and M2 intervertebral levels. Sacralization is a risk factors for a lumbar disc herniation.
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Affiliation(s)
- Fatma Fidan
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Mehtap Balaban
- Faculty of Medicine, Department of Radiology, Ankara City Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Şükrü Cem Hatipoğlu
- Faculty of Medicine, Department of Radiology, Ankara City Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000, Ankara, Turkey.
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Spine abnormalities associated with bone edema on sacroiliac joints MRI in patients with non-inflammatory chronic back pain. Joint Bone Spine 2022; 89:105436. [PMID: 35777553 DOI: 10.1016/j.jbspin.2022.105436] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/13/2022] [Accepted: 05/21/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate whether bone marrow edema (BME) fulfilling the ASAS definition of magnetic resonance imaging (MRI) sacroiliitis is associated with non-inflammatory spine abnormalities in patients with definite mechanical chronic back pain (CBP). METHODS Patients with definite mechanical CBP, according to the physician, started before the age of 45 and be lasting for more than 3months but less than 3years underwent a protocolized MRI and radiographs of sacroiliac joint (SIJ) and spine. BME and structural changes were scored, by three readers, for SIJ as well as non-inflammatory abnormalities for spine, including degenerative lesions and static disorders. Univariate analysis by Chi2 test was performed to search a statistical association between BME fulfilling the ASAS definition of MRI sacroiliitis and the presence of at least one non-inflammatory spine abnormality. RESULTS A total of 94 patients were analyzed, 27 (29%) patients had BME and 16 (17%) patients had BME fulfilling the ASAS definition of MRI sacroiliitis; 86 (91.5%) patients had at least one non-inflammatory spine abnormality which are associated into 3 distinct clusters. BME was slightly more frequent at the lower and posterior part of the SIJ. MRI sacroiliitis was associated with interspinous bursitis, facet joint effusion and lateral spinal deviation and was more likely in patients with at least one non-inflammatory spine abnormality (OR: 4.96, 95% CI [1.47; 16.72]). CONCLUSIONS BME fulfilling the ASAS definition of MRI sacroiliitis is significantly associated with non-inflammatory spine abnormalities in patients with mechanical CBP.
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Naznin RA, Moniruzzaman M, Sumi SA, Benzir M, Jahan I, Ahmad R, Haque M. Sacralization of Coccygeal Vertebra: A Descriptive Observational Study in Bangladesh. Cureus 2022; 14:e27496. [PMID: 35919212 PMCID: PMC9339143 DOI: 10.7759/cureus.27496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background: In the sacrococcygeal region, anatomical variation is due to the sacralization of the coccygeal vertebra, which is the due union of/fusion of the fifth sacral with the first coccygeal vertebra of five couples of sacral foramina under-detected or asymptomatic beyond radiological assessment. That is why it is challenging to know the cause of coccydynia, caudal block failure, the difficult second stage of labor, and perineal tears. The present study aims to improve knowledge about the anatomical variation of sacralization of the coccygeal vertebra. Additionally, to find the prevalence of sacralization of coccygeal vertebra in Sylhet, Bangladesh. Methods: This study was performed on 60 parched, totally calcified, typical sacra of mature-age individuals of undetermined sexes, fulfilling the inclusion criteria from the bone bank of the osteology museum of the Department of Anatomy, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh, from July 2017 to June 2018. Sex determination of the collected unknown sacra was conducted using discriminant function analysis. It was found that 50% (30) were male and 50% (30%) were female. The unpaired t-tests and chi-square were utilized to determine the statistical significance. Results: Out of 60 sacra, eight (13.33%) samples presented with sacralization. This study found that males had significantly higher straight (p=0.05) and curved (p=0.05) lengths of sacrococcygeal vertebrae. The sacrococcygeal curvature index (SCI) showed statistically significant (p=0.05) differences between the sexes. Conclusion: Sacralization may exert an impact on the caudal block. It could extend the second stage of the labor process with perineal tears. Therefore, knowledge about the anatomical variation of the coccygeal vertebra is essential.
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Barkhane Z, Belaaroussi S, Foudail M. Bilateral Bertolotti's Syndrome: A Case Report of an Uncommon Presentation of Chronic Low Back Pain in an Elder Patient. Cureus 2022; 14:e26569. [PMID: 35936116 PMCID: PMC9351821 DOI: 10.7759/cureus.26569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 12/05/2022] Open
Abstract
Lower back pain caused by anatomical lumbosacral transitional vertebra is known as Bertolotti's syndrome. We present the case of a 65-year-old male with persistent chronic lower back pain with radiological evidence of an anatomical lumbosacral pseudo-joint bilaterally. The patient underwent conservative treatment with lidocaine and steroids that helped to improve and manage his symptoms. Our patient is an elderly one, and it is quite uncommon for the first appearance of Bertolotti's syndrome. Therefore, Bertolotti's syndrome is a rare cause of lower back pain, and clinicians should consider it in the differential diagnosis.
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Mulley JF. Regulation of posterior Hox genes by sex steroids explains vertebral variation in inbred mouse strains. J Anat 2022; 240:735-745. [PMID: 34747015 PMCID: PMC8930804 DOI: 10.1111/joa.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
A series of elegant embryo transfer experiments in the 1950s demonstrated that the uterine environment could alter vertebral patterning in inbred mouse strains. In the intervening decades, attention has tended to focus on the technical achievements involved and neglected the underlying biological question: how can genetically homogenous individuals have a heterogenous number of vertebrae? Here I revisit these experiments and, with the benefit of knowledge of the molecular-level processes of vertebral patterning gained over the intervening decades, suggest a novel hypothesis for homeotic transformation of the last lumbar vertebra to the adjacent sacral type through regulation of Hox genes by sex steroids. Hox genes are involved in both axial patterning and development of male and female reproductive systems and have been shown to be sensitive to sex steroids in vitro and in vivo. Regulation of these genes by sex steroids and resulting alterations to vertebral patterning may hint at a deep evolutionary link between the ribless lumbar region of mammals and the switch from egg-laying to embryo implantation. An appreciation of the impact of sex steroids on Hox genes may explain some puzzling aspects of human disease, and highlights the spine as a neglected target for in utero exposure to endocrine disruptors.
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Zhou S, Du L, Liu X, Wang Q, Zhao J, Lv Y, Yang H. Quantitative measurements at the lumbosacral junction are more reliable parameters for identifying and numbering lumbosacral transitional vertebrae. Eur Radiol 2022; 32:5650-5658. [PMID: 35258678 DOI: 10.1007/s00330-022-08613-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate quantitative parameters to identify the anatomic variation lumbosacral transitional vertebrae (LSTV) and compare them with the landmarks commonly used at present. METHODS A total of 2,845 PET/CT scans were reviewed, and the patients with 23 and 25 presacral vertebrae were included. The quantitative parameters, including the anterior-edge vertebral angle (AVA) of the lowest lumbar-type vertebra, the ratio of the length of the inferior endplate to that of the superior endplate (RISE) of the uppermost sacral-type vertebra and the lumbosacral intervertebral disc angle (LSIVDA), and the anatomical landmarks, including the iliac crest tangent (ICT) level, the iliolumbar ligament (ILL) origin level and psoas proximal insertion, were all evaluated to determine their ability to identify LSTV. RESULTS The values of AVA and RISE were significantly different between the LSTV group and the control group, and between subgroups of LSTV. The cutoff value for AVA was 73.0°, with an accuracy, sensitivity, and specificity of 91.1%, 77.5%, and 88.3%, and that for RISE was 0.79, with an accuracy, sensitivity, and specificity of 90.3%, 77.5%, and 94.2%, while that for LSIVDA was 14.15°, with an accuracy, sensitivity, and specificity of 75.9%, 65.7%, and 78.3%, to differentiate L5 sacralization from S1 lumbarization. For differentiating the controls from LSTV, the accuracy, sensitivity, and specificity of the ICT level and proximal psoas insertion were 78.0%, 70.2%, and 95.0%, versus 71.7%, 61.7%, and 94.0%. CONCLUSIONS Compared with the anatomical landmarks, the quantitative measurements at the lumbosacral junction, including AVA and RISE, may be more helpful for differentiating subgroups of LSTV especially if only lumbar spine imaging is available. KEY POINTS • The quantitative parameters, the anterior-edge vertebral angle (AVA) of the lowest lumbar-type vertebra and the ratio of the length of the inferior endplate to that of the superior endplate (RISE) of the uppermost sacral-type vertebra, are more helpful for distinguishing L5 sacralization from S1 lumbarization than the previously proposed anatomic landmarks. • AVA and RISE represent relevant changes in the curvature at the lumbosacral region and the shape of the transitional vertebral body, respectively. • AVA and RISE are easily assessed, with high intra- and inter-reader reliability.
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Affiliation(s)
- Suying Zhou
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Lin Du
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xin Liu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiqi Wang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jie Zhao
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yuchan Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Haitao Yang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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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: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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Reliability of coeliac and superior mesenteric artery origin level in lumbosacral transitional vertebrae detection and vertebral numbering. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1030355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Olstad K, Aasmundstad T, Kongsro J, Grindflek E. Osteochondrosis and other lesions in all intervertebral, articular process and rib joints from occiput to sacrum in pigs with poor back conformation, and relationship to juvenile kyphosis. BMC Vet Res 2022; 18:44. [PMID: 35042517 PMCID: PMC8764802 DOI: 10.1186/s12917-021-03091-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Computed tomography (CT) is used to evaluate body composition and limb osteochondrosis in selection of breeding boars. Pigs also develop heritably predisposed abnormal curvature of the spine including juvenile kyphosis. It has been suggested that osteochondrosis-like changes cause vertebral wedging and kyphosis, both of which are identifiable by CT. The aim of the current study was to examine the spine from occiput to sacrum to map changes and evaluate relationships, especially whether osteochondrosis caused juvenile kyphosis, in which case CT could be used in selection against it. Whole-body CT scans were collected retrospectively from 37 Landrace or Duroc boars with poor back conformation scores. Spine curvature and vertebral shape were evaluated, and all inter-vertebral, articular process and rib joints from the occiput to the sacrum were assessed for osteochondrosis and other lesions. Results Twenty-seven of the 37 (73%) pigs had normal spine curvature, whereas 10/37 (27%) pigs had abnormal curvature and all of them had wedge vertebrae. The 37 pigs had 875 focal lesions in articular process and rib joints, 98.5% of which represented stages of osteochondrosis. Five of the 37 pigs had focal lesions in other parts of vertebrae, mainly consisting of vertebral body osteochondrosis. The 10 pigs with abnormal curvature had 21 wedge vertebrae, comprising 10 vertebrae without focal lesions, six ventral wedge vertebrae with ventral osteochondrosis lesions and five dorsal wedge vertebrae with lesions in the neuro-central synchondrosis, articular process or rib joints. Conclusions Computed tomography was suited for identification of wedge vertebrae, and kyphosis was due to ventral wedge vertebrae compatible with heritably predisposed vertebral body osteochondrosis. Articular process and rib joint osteochondrosis may represent incidental findings in wedge vertebrae. The role of the neuro-central synchondrosis in the pathogenesis of vertebral wedging warrants further investigation. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-03091-6.
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Chen ZJ, Cheng WJ, Chen JL, Chen CH, Chen CPC. Ultrasound-Guided Injection Treatment of Low Back Pain Caused by Bertolotti Syndrome. Am J Phys Med Rehabil 2022; 101:e15-e16. [PMID: 34915547 DOI: 10.1097/phm.0000000000001810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Zhi-Jia Chen
- From the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Guishan District, Taoyuan City, Taiwan
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Byvaltsev VA, Kalinin AA, Biryuchkov MY, Khozeev DV, Dzhubayeva BA, Pestryakov YY. [Analysis of unfavorable postoperative outcomes in patients with lumbosacral junction anomalies]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:39-47. [PMID: 35170275 DOI: 10.17116/neiro20228601139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The absence of a unified diagnostic approach and heterogeneous treatment strategies in patients with lumbosacral transitional vertebra contribute to registration of contradictory data on postoperative outcomes in these patients. OBJECTIVE A retrospective analysis of postoperative outcomes in patients with degenerative lumbar spine diseases associated with lumbosacral junction anomalies and causes of unfavorable results. MATERIAL AND METHODS Lumbosacral transitional vertebra was preoperatively verified and classified according to Castellvi A.E. in 352 cases between 2007 and 2017. Full-time examination, phone and e-mail survey covered 314 (89.2%) patients throughout 5.2-year follow-up period. There were unfavorable clinical outcomes in 42 cases. We analyzed the causes of these results and relationship of surgical strategy with the type of lumbosacral junction anomaly. RESULTS Lumbosacral transitional vertebra Castellvi type IIA (30.9%) and IIIA (34.9%) prevailed. Unfavorable outcomes occurred in 7 cases after percutaneous interventions, in 12 patients after decompression surgery and in 23 patients after decompression and stabilization procedures. In all cases (n=42), redo surgery was performed: rigid fixation or extension of stabilization system in 16 cases, additional intracanal decompression in 10 patients, foraminal/extraforaminal decompression in 8 patients. Seven patients underwent repeated laser denervation. Of these, 5 patients underwent dorsal decompression without discectomy due to ineffective denervation. Correlation analysis showed the relationship between unfavorable outcomes after percutaneous procedures with LV transverse process dysplasia and sacralization, decompressive interventions with additional articular joints and lumbarization, decompression/stabilization procedures with LV transverse process dysplasia and sacralization. CONCLUSION Unfavorable outcomes occurred after percutaneous interventions for anomaly type IB and IIIB, decompressive procedures for anomaly type IIA, IIB and IV, decompression/ stabilization procedures for types IA and IIIA. It is the first report devoted to analysis of relationships between unsatisfactory postoperative outcomes, surgical technique and type of lumbosacral dysgenesis.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia
- Clinical Hospital Russian Railways-Medicine, Irkutsk, Russia
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia
- Clinical Hospital Russian Railways-Medicine, Irkutsk, Russia
| | - M Yu Biryuchkov
- Marat Ospanov West Kazakhstan Medical University, Aktobe, Kazakhstan
| | - D V Khozeev
- Irkutsk State Medical University, Irkutsk, Russia
| | - B A Dzhubayeva
- Marat Ospanov West Kazakhstan Medical University, Aktobe, Kazakhstan
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Liebrand B, Brakel K, Boon A, van der Weegen W, Wal SVD, Vissers KC. Diagnostic treatment-level discrepancies in patients with lumbosacral radicular pain and lumbar spine anomalies. Reg Anesth Pain Med 2021; 47:177-182. [PMID: 34921051 DOI: 10.1136/rapm-2021-103174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lumbosacral transitional vertebra can result in an anomalous number of lumbar vertebrae associated with wrong level treatment. The primary aim of this study was to characterize discrepancies between reported referring levels and levels from MRI reports with treated levels. The secondary aim was to analyze interobserver variability between a pain physician and a radiologist when determining levels and classifying lumbosacral transitional vertebrae. METHODS Between February 2016 and October 2019, a retrospective case series of prospectively collected data of the affected levels mentioned in referrals, MRI reports and treated levels was performed. The counting process, level determination, classification of lumbosacral transitional vertebrae and a secondary control were carried out by independent researchers using a standard methodology. RESULTS Of the 2443 referrals, 143 patients had an anomalous number of lumbar vertebrae; of these, 114 were included for analysis. The vertebral level noted in the patient's file, in the referral, and the reported level of treatment differed in 40% of these cases. The vertebral level between the MRI reports and treatment differed in 46% of cases. The interobserver reliability (radiologist vs pain physician) for classifying a transitional vertebra was fair ((κ=0.40) and was substantial (κ=0.70) when counting the vertebrae. CONCLUSION In the presence of lumbar spine anomalies, we report a high prevalence of discrepancies between referral levels and MRI pathological findings with treatment levels. Further research is needed to better understand clinical implications.
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Affiliation(s)
- Bart Liebrand
- Department of Anaesthesiology and Pain Medicine, St Anna Hospital, Geldrop, The Netherlands
| | - Koen Brakel
- Department of Radiology, St Anna Hospital, Geldrop, The Netherlands
| | - Arthur Boon
- Department of Neurology, St Anna Hospital, Geldrop, The Netherlands
| | | | - Selina van der Wal
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kris Cp Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
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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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Kawtharani S, Bsat SA, El Housheimy M, Moussalem C, Halaoui A, Sunna T. A case of Bertolotti's syndrome as a cause of sciatica. Surg Neurol Int 2021; 12:516. [PMID: 34754566 PMCID: PMC8571205 DOI: 10.25259/sni_756_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/01/2021] [Indexed: 11/11/2022] Open
Abstract
Background: Bertolotti’s syndrome (i.e., varying extent of fusion between the last lumbar vertebra and the first sacral segment) or lumbosacral transitional vertebrae is a rare cause of back pain. Notably, this syndrome is one of the differential diagnoses for patients with refractory back pain/sciatica. Case Description: A 71-year-old male presented with low back pain of 3 years duration that radiated into the right lower extremity resulting in numbness in the L5 distribution. He then underwent a minimally invasive approach to resect the L5 “wide” transverse process following the CT diagnosis of Bertolotti’s syndrome. Prior to surgery, patient reported pain that was exacerbated by ambulation that resolved post-operative. Conclusion: Bertolotti’s syndrome is one of the rare causes of sciatica that often goes undiagnosed. Nevertheless, it should be ruled out for patients with back pain without disc herniations or other focal pathology diagnosed on lumbar MR scans.
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Affiliation(s)
- Sarah Kawtharani
- Department of Neurosurgery, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Shadi Abdelatif Bsat
- Department of Neurosurgery, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Mohamad El Housheimy
- Department of Neurosurgery, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Charbel Moussalem
- Department of Neurosurgery, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Adham Halaoui
- Department of Neurosurgery, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Tarek Sunna
- Department of Neurosurgery, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
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Crane J, Cragon R, O'Neill J, Berger AA, Kassem H, Sherman WF, Paladini A, Varrassi G, Odisho AS, Miriyala S, Kaye AD. A Comprehensive Update of the Treatment and Management of Bertolotti's Syndrome: A Best Practices Review. Orthop Rev (Pavia) 2021; 13:24980. [PMID: 34745474 DOI: 10.52965/001c.24980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022] Open
Abstract
Bertolotti's Syndrome is defined as chronic back pain caused by transitional lumbosacral vertebra. The transitional vertebra may present with numerous clinical manifestations leading to a myriad of associated pain types. The most common is pain in the sacroiliac joint, groin, and hip region and may or may not be associated with radiculopathy. Diagnosis is made through a combination of clinical presentations and imaging studies and falls into one of four types. The incidence of transitional vertebra has a reported incidence between 4 and 36%; however, Bertolotti's Syndrome is only diagnosed when the cause of pain is attributed to this transitional anatomy. Therefore, the actual incidence is difficult to determine. Initial management with conservative treatment includes medical management and physical therapy. Injection therapy has been established as an effective second line. Epidural steroid injection at the level of the transitional articulation is effective, with either local anesthetics alone or in combination with steroids. Surgery carries higher risks and is reserved for patients failing previous lines of treatment. Options include surgical removal of the transitional segment, decompression of stenosed foramina, and spinal fusion. Recent evidence suggests that radiofrequency ablation (RFA) around the transitional segment may also provide relief. This manuscript is a comprehensive review of the literature related to Bertolotti's Syndrome. It describes the background, including epidemiology, pathophysiology, and etiology of the Syndrome, and presents the best evidence available regarding management options. Bertolotti's Syndrome is considered an uncommon cause of chronic back pain, though the actual incidence is unclear. Most evidence supporting these therapies is of lower-level evidence with small cohorts, and more extensive studies are required to provide strong evidence supporting best practices.
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Affiliation(s)
| | | | | | - Amnon A Berger
- Beth Israel Deaconess Medical Center, Harvard Medical School
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Identifying treatment patterns in patients with Bertolotti syndrome: an elusive cause of chronic low back pain. Spine J 2021; 21:1497-1503. [PMID: 34010681 DOI: 10.1016/j.spinee.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Bertolotti Syndrome is a diagnosis given to patients with lower back pain arising from a lumbosacral transitional vertebra (LSTV). These patients can experience symptomatology similar to common degenerative diseases of the spine, making Bertolotti Syndrome difficult to diagnose with clinical presentation alone. Castellvi classified the LSTV seen in this condition and specifically in types IIa and IIb, a "pseudoarticulation" is present between the fifth lumbar transverse process and the sacral ala, resulting in a semi-mobile joint with cartilaginous surfaces.Treatment outcomes for Bertolotti Syndrome are poorly understood but can involve diagnostic and therapeutic injections and ultimately surgical resection of the pseudoarticulation (pseudoarthrectomy) or fusion of surrounding segments. PURPOSE To examine spine and regional injection patterns and clinical outcomes for patients with diagnosed and undiagnosed Bertolotti Syndrome. DESIGN Retrospective observational cohort study of patients seen at a single institution's tertiary spine center over a 10-year period. PATIENT SAMPLE Cohort consisted of 67 patients with an identified or unidentified LSTV who were provided injections or surgery for symptoms related to their chronic low back pain and radiculopathy. OUTCOME MEASURES Self-reported clinical improvement following injections and pseudoarthrectomy. METHODS Patient charts were reviewed. Identification of a type II LSTV was confirmed through provider notes and imaging. Variables collected included demographics, injection history and outcomes, and surgical history for those who underwent pseudoarthrectomy. RESULTS A total of 22 out of 67 patients (33%) had an LSTV that was not identified by their provider. Diagnosed patients underwent fewer injections for their symptoms than those whose LSTV was never previously identified (p = 0.031). Only those diagnosed received an injection at the LSTV pseudoarticulation, which demonstrated significant symptomatic improvement at immediate follow up compared to all other injection types (p = 0.002). Patients who responded well to pseudoarticulation injections were offered a pseudoarthrectomy, which was more likely to result in symptom relief at most recent follow up than patients who underwent further injections without surgery (p < 0.001). CONCLUSIONS Undiagnosed patients are subject to a higher quantity of injections at locations less likely to provide relief than pseudoarticulation injections. These patients in turn cannot be offered a pseudoarthrectomy which can result in significant relief compared to continued injections alone. Proper and timely identification of an LSTV dramatically alters the clinical course of these patients as they can only be offered treatment directed towards the LSTV once it is identified.
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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: 3.8] [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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Lee EG, Park SY, Lee K, Jang M, Kim JT, Choi S, Park I. Radiographic evaluation of congenital vertebral anomalies in Korean raccoon dogs ( Nyctereutes procyonoides koreensis). J Vet Sci 2021; 22:e52. [PMID: 34170093 PMCID: PMC8318798 DOI: 10.4142/jvs.2021.22.e52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/23/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background The normal vertebral anatomy of Korean raccoon dogs and their variants require research attention as a prerequisite for identifying pathologies and anomalies. Objectives This retrospective study aimed at describing the vertebral formula and congenital vertebral anomalies in Korean raccoon dogs (Nyctereutes procyonoides koreensis). Methods Radiographs of 82 raccoon dogs (42 males, 40 females) acquired from May 2013 to June 2020 in the Gangwon Wildlife Medical Rescue Center were reviewed to evaluate the cervical, thoracic, and lumbar vertebrae of the spine. Results Normal morphology of all vertebrae was observed in 50 of the 82 raccoon dogs, and the vertebral formula was cervical 7, thoracic 13, and lumbar 7. Congenital vertebral anomalies were found in 32 raccoon dogs: transitional vertebrae (TV) in 31 and block vertebrae in 2. Two raccoon dogs had 2 types of vertebral anomalies: one had TV and block vertebra, and the other had 2 types of TV. Twenty-nine raccoon dogs had thoracolumbar TV (TTV) and 3 had lumbosacral TV. TTV was morphologically classified into 4 different types: unilateral extra-rib in 5 raccoon dogs, bilateral extra-ribs in 14, bilateral elongated transverse processes in 4, and an asymmetric mixed formation of extra-rib with elongated transverse process in 6. Conclusions This study showed that TTV is common in Korean raccoon dogs, and that the vertebral formula is relatively diverse. The bilateral extra-ribs type TTV is the most common variant, which is almost similar to normal rib to be confused the radiographic evaluation.
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Affiliation(s)
- Eun Gee Lee
- College of Veterinary Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Sool Yi Park
- College of Veterinary Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Kija Lee
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Min Jang
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Jong Taek Kim
- College of Veterinary Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Sooyoung Choi
- College of Veterinary Medicine, Kangwon National University, Chuncheon 24341, Korea.
| | - Inchul Park
- College of Veterinary Medicine, Kangwon National University, Chuncheon 24341, Korea.
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Knopf J, Lee S, Bulsara K, Moss I, Choi D, Onyiuke H. Onyiuke Grading Scale: A clinical classification system for the diagnosis and management of Bertolotti syndrome. Neurochirurgie 2021; 67:540-546. [PMID: 34051248 DOI: 10.1016/j.neuchi.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/29/2021] [Accepted: 05/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lumbosacral transitional vertebrae (LSTV) is a common anatomic variant of the spine, characterized by the formation of a pseudoarticulation between the transverse process of the lumbar vertebrae and sacrum or ilium. LSTVs have been implicated as a potential source of low back pain - dubbed Bertolotti syndrome. Traditionally, LSTVs have only been subdivided into types I-IV based on the Castellvi radiographic classification system. OBJECTIVE Solely identifying the type of LSTV radiographically provides no clinical relevance to the treatment of Bertolotti syndrome. Here, we seek to analyze such patients and identify a clinical grading scale and diagnostic-therapeutic algorithm to optimize care for patients with this congenital anomaly. METHODS Patients presenting with back pain between 2011 and 2018 attributable to a lumbosacral transitional vertebra were identified retrospectively. Data was collected from these patients' charts regarding demographic information, clinical presentation, diagnostic imaging, treatment and outcomes. Based on evaluation of these cases and review of the literature, a diagnostic-therapeutic algorithm is proposed. RESULTS Based on our experiences evaluating and treating these patients and review of the existing literature, we propose a clinical classification system for Bertolotti syndrome: we proposed a 4-grade scale for patients with Bertolotti syndrome based upon location, severity, and characteristics of pain experienced due to LSTVs. CONCLUSION Based on our experience with the cases illustrated here, we recommend managing patients with LSTV based on our diagnostic-therapeutic algorithm. Moving forward, a larger prospective study with a larger patient cohort is needed to further validate the treatment paradigm.
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Affiliation(s)
- J Knopf
- University of Connecticut School of Medicine, Farmington, CT, USA.
| | - S Lee
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - K Bulsara
- Department of Neurosurgery, UConn Health, Farmington, CT, USA
| | - I Moss
- Department of Orthopedic Surgery, UConn Health, Farmington, CT, USA
| | - D Choi
- Department of Neurosurgery, UConn Health, Farmington, CT, USA
| | - H Onyiuke
- Department of Neurosurgery, UConn Health, Farmington, CT, USA
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The effectiveness of preoperative assessment using a patient-specific three-dimensional pseudoarticulation model for minimally invasive posterior resection in a patient with Bertolotti's syndrome: a case report. J Med Case Rep 2021; 15:68. [PMID: 33588921 PMCID: PMC7885622 DOI: 10.1186/s13256-020-02635-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bertolotti’s syndrome is widely known to cause low back pain in young patients and must be considered as a differential diagnosis. Its treatment such as conservative therapy or surgery remains controversial. Surgical procedure is recommended for intractable low back pain. The three-dimensional (3D) lumbosacral transitional vertebrae anatomy should be completely understood for a successful surgery. Using an intraoperative 3D navigation and preoperative preliminary surgical planning with a patient-specific 3D plaster model contribute for safe surgery and good outcome. Case presentation A case of a 22-year-old Japanese male patient with intractable left low back pain due to lumbosacral transitional vertebrae with Bertolotti’s syndrome. The symptom resisted the conservative treatment, and anesthetic injection at pseudoarticulation only provided a short-term pain relief. Posterior resection using intraoperative three-dimensional (3D) navigation has been performed through microendoscopic view. Pseudoarticulation was totally and successfully resected in a safe manner. Conclusions Preoperative surgical planning and rehearsal using a patient-specific 3D plaster model was greatly useful and effective for surgeons in performing accurate and safe pseudoarticulation resection.
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Luo R, Barsoum D, Ashraf H, Cheng J, Hurwitz NR, Goldsmith C, Moley PJ. Prevalence of Lumbosacral Transitional Vertebrae in Patients With Symptomatic Femoroacetabular Impingement Requiring Hip Arthroscopy. Arthroscopy 2021; 37:149-155. [PMID: 32919025 PMCID: PMC8177691 DOI: 10.1016/j.arthro.2020.08.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to determine the prevalence of lumbosacral transitional vertebrae (LSTVs) in patients with symptomatic femoroacetabular impingement (FAI) requiring hip arthroscopy. The secondary aim was to determine whether there is an association between LSTV anatomy and patient-reported outcomes. METHODS This retrospective study included patients aged 18 to 45 years with symptomatic FAI who underwent arthroscopy between March 2010 and March 2016 and had anteroposterior pelvic radiographs. The exclusion criteria included lack of an FAI diagnosis, hip osteoarthritis (Tönnis grade ≥ 2), prior spinal fusion surgery, prior total hip arthroplasty, indications for total hip arthroplasty, and revision surgery on the affected hip. All radiographs were assessed by an interventional spine and sports fellow. The primary outcome was the prevalence of LSTVs, classified using the criteria of Castellvi et al. Secondary outcomes included the modified Harris Hip Score, Hip Outcome Score, and International Hip Outcome Tool 33 score. RESULTS A total of 1,880 patients were included. Review of the patients' radiographs yielded 262 LSTVs, for an overall prevalence of 13.9% (type IA in 104 [5.5%], type IB in 53 [2.8%], type IIA in 60 [3.2%], type IIB in 25 [1.3%], type IIIA in 8 [0.4%], type IIIB in 0 [0%], and type IV in 12 [0.64%]). The prevalence of type II, III, and IV LSTVs was 5.6% (n = 105). Unilateral LSTV sidedness did not correlate with symptom laterality (κ = 0.07). There were no differences in patient-reported outcomes between patients with LSTV anatomy and those without it. CONCLUSIONS In this large cohort of 1,880 patients with symptomatic FAI, the prevalence of LSTVs was 13.9%. There was no correlation between sidedness of unilateral LSTVs and the symptomatic hip. Furthermore, there was no association between LSTV anatomy and patient-reported outcomes. The prevalence of LSTVs in this cohort was similar to the prevalence rates previously reported in patients with low-back pain. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Roger Luo
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Dena Barsoum
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Humaira Ashraf
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Nicole R. Hurwitz
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Campbell Goldsmith
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Peter J. Moley
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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