Golubovsky Joshua L, Momin Arbaz, Thompson Nicolas R, Steinmetz Michael P
1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute, Cleveland Clinic, Cleveland.
2Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland.
J Neurosurg Spine. 2019 Apr 19;31(2):222-228. doi: 10.3171/2019.2.SPINE1953. Print 2019 Aug 1.
Bertolotti syndrome is a rare spinal condition that causes low-back pain due to a lumbosacral transitional vertebra (LSTV), which is a pseudoarticulation between the fifth lumbar transverse process and the sacral ala. Bertolotti syndrome patients are rarely studied, particularly with regard to their quality of life. This study aimed to examine the quality of life and prior treatments in patients with Bertolotti syndrome at first presentation to the authors' center in comparison with those with lumbosacral radiculopathy.
This study was a retrospective cohort analysis of patients with Bertolotti syndrome and lumbosacral radiculopathy due to disc herniation seen at the authors' institution's spine center from 2005 through 2018. Diagnoses were confirmed with provider notes and imaging. Variables collected included demographics, diagnostic history, prior treatment, patient-reported quality of life metrics, and whether or not they underwent surgery at the authors' institution. Propensity score matching by age and sex was used to match lumbosacral radiculopathy patients to Bertolotti syndrome patients. Group comparisons were made using t-tests, Fisher's exact test, Mann-Whitney U-tests, Cox proportional hazards models, and linear regression models where variables found to be different at the univariate level were included as covariates.
The final cohort included 22 patients with Bertolotti syndrome who had patient-reported outcomes data available and 46 propensity score-matched patients who had confirmed radiculopathy due to disc herniation. The authors found that Bertolotti syndrome patients had significantly more prior epidural steroid injections (ESIs) and a longer time from symptom onset to their first visit. Univariate analysis showed that Bertolotti syndrome patients had significantly worse Patient-Reported Outcomes Measurement Information System (PROMIS) mental health T-scores. Adjustment for prior ESIs and time from symptom onset revealed that Bertolotti syndrome patients also had significantly worse PROMIS physical health T-scores. Time to surgery and other quality of life metrics did not differ between groups.
Patients with Bertolotti syndrome undergo significantly longer workup and more ESIs and have worse physical and mental health scores than age- and sex-matched patients with lumbosacral radiculopathy. However, both groups of patients had mild depression and clinically meaningful reduction in their quality of life according to all instruments. This study shows that Bertolotti syndrome patients have a condition that affects them potentially more significantly than those with lumbosacral radiculopathy, and increased attention should be paid to these patients to improve their workup, diagnosis, and treatment.
贝托洛蒂综合征是一种罕见的脊柱疾病，由腰骶部移行椎（LSTV）引起下腰痛，LSTV是第五腰椎横突与骶骨翼之间的假关节。很少有对贝托洛蒂综合征患者的研究，尤其是关于他们的生活质量。本研究旨在比较首次就诊于作者所在中心的贝托洛蒂综合征患者与腰骶神经根病患者的生活质量和既往治疗情况。
本研究是一项对2005年至2018年在作者所在机构脊柱中心就诊的贝托洛蒂综合征患者和因椎间盘突出导致腰骶神经根病患者的回顾性队列分析。诊断通过医生记录和影像学检查得以证实。收集的变量包括人口统计学资料、诊断史、既往治疗、患者报告的生活质量指标，以及他们是否在作者所在机构接受了手术。采用年龄和性别倾向得分匹配法将腰骶神经根病患者与贝托洛蒂综合征患者进行匹配。使用t检验、Fisher精确检验、Mann-Whitney U检验、Cox比例风险模型和线性回归模型进行组间比较，将在单变量水平发现不同的变量作为协变量纳入。
最终队列包括22例有患者报告结局数据的贝托洛蒂综合征患者和46例倾向得分匹配的因椎间盘突出确诊为神经根病的患者。作者发现，贝托洛蒂综合征患者既往硬膜外类固醇注射（ESI）明显更多，从症状出现到首次就诊的时间更长。单变量分析显示，贝托洛蒂综合征患者的患者报告结局测量信息系统（PROMIS）心理健康T评分明显更差。对既往ESI和症状出现时间进行调整后发现，贝托洛蒂综合征患者的PROMIS身体健康T评分也明显更差。两组患者的手术时间和其他生活质量指标没有差异。
与年龄和性别匹配的腰骶神经根病患者相比，贝托洛蒂综合征患者的检查时间明显更长，接受的ESI更多，身心健康评分更差。然而，根据所有测评工具，两组患者均有轻度抑郁，生活质量有具有临床意义的下降。本研究表明，贝托洛蒂综合征患者所患疾病对他们的影响可能比腰骶神经根病患者更大，应更加关注这些患者，以改善他们的检查、诊断和治疗。
