Rui Zhang* and Jianguo Cheng
Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Ohio, USAFulltext PDF
Background: Bertolotti's syndrome is a congenital variant with an enlarged transverse process of the L5 lumbar vertebra (lumbosacral transitional vertebra, LSTV), which articulates or fuses with the sacrum or ilium. It’s believed that the presence of an LSTV increases the incidence of chronic low back pain and the severity of the pain. Its association with chronic low back pain is multifactorial, including biomechanical changes resulting from asymmetrical motion between the LSTV and the sacrum. The conventional conservative management that consists of physical therapy, activity modification, and medication may not be sufficient to provide satisfactory pain control due to the underlying congenital anatomical variance. Here we report 5 cases that were managed with interventional procedures for chronic low back pain associated with Bertolotti’s syndrome.Case Report: All the cases have failed to respond to conventional conservative management and were found to have Bertolotti’s syndrome through radiographs. The pain generating mechanism varied among these five patients, which led to diverse clinic presentations and applications of various interventional procedures including epidural steroid injections, lumbar facet medical branch block and neurotomy, and sacroiliac joint injection and neurotomy.Conclusion: In light of the diversity of clinical presentations, management of patients with Bertolotti’s syndrome has to be highly individualized. Multimodal care, including interventional approaches, is often required based on clinical data, imaging, and diagnostic blocks.
Zhang R, Cheng J. Interventional Management of Chronic Low Back Pain Associated with Bertolotti&s Syndrome: Report of Case Series. Ann Clin Case Rep. 2017; 2: 1348.