Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea.
Dept. of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea.
Pain Physician. 2017 Sep;20(6):E923-E932.
Bertolotti's syndrome is a spinal disorder characterized by abnormal enlargement of the transverse process of the most caudal lumbar vertebra. The L5 transverse process may be enlarged either unilaterally or bilaterally and may articulate or fuse with the sacrum or ilium. Pseudoarticulation between the transverse process of the L5 and the alar of the sacrum can cause buttock pain and leg pain. In addition, the L4 exiting nerve root could be compressed by an enlarged L5 transverse process. The authors could have obtained satisfactory results from the selected cases of Bertolotti's syndrome by applying a selective transverse processectomy of the L5.
The objective of this study is to determine the effectiveness of L5 transverse processectomy for symptomatic Bertolotti's syndrome.
A retrospective study.
A total of 256 patients with Bertolotti's syndrome who had severe buttock pain and unilateral or bilateral radiating leg pain were selected. The correct diagnosis was made based on imaging studies which included computed tomography (CT), plain x-rays, and magnetic resonance imaging (MRI). The final diagnosis was made by confirming pain relief from anesthetic block. A total of 87 patients were classified into 2 groups: group A included 50 patients whose pain was relieved by block into the pseudoarticulation and group B included 37 patients whose pain was relieved by block into the L4 exiting nerve root. A total of 61 cases (group A: 39 cases, group B: 22 cases) were selected as pure L5 transverse processectomy.
The primary outcome measures were reduction in pain scores and improvement in quality of life.
Among 61 patients, there were 19 men and 42 women. The mean age of the patients was 53.2 ± 12 years (group A: 57.8 ± 14 years [16 - 86 years], group B: 53.4 ± 14 years [27 - 77 years]). The mean follow-up period was 6.5 months. The patients' mean visual analog scale (VAS) prior to surgery was 7.54 ± 0.81 (group A: 7.59 ± 0.93, group B: 7.50 ± 0.86), and the mean postoperative VAS was 2.86 ± 1.67 (group A: 3.82 ± 1.59, group B: 2.05 ± 1.00). According to Macnab's criteria, 12 patients showed excellent results (group A: 3, group B: 9), 41 patients showed good results (group A: 11, group B: 30), 6 patients showed fair results (group A: 5, group B: 1), and 2 patients showed poor results (group A: 2, group B: 0). Thus, satisfactory results were achieved in 86.89% of the cases.
In patients with Bertolotti's syndrome, pseudoarticulation as well as L4 nerve root compression can be the source of buttock pain and lower extremity pain. Bisectional cutting of the L5 transverse process and decompression of the L4 nerve root could be an optimal treatment for Bertolotti's syndrome, and it may be easily approached by the paraspinal approach.
This is a retrospective study and only offers one-year follow-up data for patients with Bertolotti's syndrome who have undergone L5 transverse process resection.Key words: Bertolotti's syndrome, pseudoarticulation, L5 transverse processectomy, paraspinal approach.
Bertolotti 综合征是一种脊柱疾病，其特征为最尾端腰椎的横突异常增大。L5 横突可能单侧或双侧增大，并可能与骶骨或髂骨关节或融合。L5 横突与骶骨翼之间的假性关节可引起臀部和腿部疼痛。此外，增大的 L5 横突可压迫 L4 神经根。通过选择性 L5 横突切除术，作者可以从选定的 Bertolotti 综合征病例中获得满意的结果。
本研究旨在确定 L5 横突切除术治疗症状性 Bertolotti 综合征的有效性。
回顾性研究。
共选择 256 例患有 Bertolotti 综合征的患者，这些患者有严重的臀部疼痛和单侧或双侧放射状腿部疼痛。根据包括计算机断层扫描（CT）、普通 X 光和磁共振成像（MRI）在内的影像学研究做出正确诊断。最终诊断通过确认麻醉阻滞的疼痛缓解来确定。共有 87 例患者分为 2 组：A 组 50 例，疼痛缓解至假性关节；B 组 37 例，疼痛缓解至 L4 神经根。共有 61 例（A 组：39 例，B 组：22 例）被选为单纯 L5 横突切除术。
主要结果测量为疼痛评分降低和生活质量改善。
61 例患者中，男性 19 例，女性 42 例。患者平均年龄为 53.2 ± 12 岁（A 组：57.8 ± 14 岁[16-86 岁]，B 组：53.4 ± 14 岁[27-77 岁]）。平均随访时间为 6.5 个月。患者术前平均视觉模拟评分（VAS）为 7.54 ± 0.81（A 组：7.59 ± 0.93，B 组：7.50 ± 0.86），术后平均 VAS 为 2.86 ± 1.67（A 组：3.82 ± 1.59，B 组：2.05 ± 1.00）。根据 Macnab 标准，12 例患者结果优秀（A 组 3 例，B 组 9 例），41 例患者结果良好（A 组 11 例，B 组 30 例），6 例患者结果中等（A 组 5 例，B 组 1 例），2 例患者结果较差（A 组 2 例，B 组 0 例）。因此，86.89%的病例取得了满意的结果。
在患有 Bertolotti 综合征的患者中，假性关节以及 L4 神经根受压均可成为臀部和下肢疼痛的根源。L5 横突的二分切开和 L4 神经根减压可能是治疗 Bertolotti 综合征的最佳方法，通过脊柱旁入路可以很容易地接近。
这是一项回顾性研究，仅为接受 L5 横突切除术的 Bertolotti 综合征患者提供了一年的随访数据。
Bertolotti 综合征，假性关节，L5 横突切除术，脊柱旁入路。
