Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Spine J. 2021 Aug;21(8):1286-1296. doi: 10.1016/j.spinee.2021.02.023. Epub 2021 Mar 3.
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.
贝氏综合征是一种由于腰骶部过渡性椎体（LSTV）存在而引起疼痛的诊断，其特征是 L5 横突增大，可能与骶骨假性关节或融合。卡斯特尔维分类系统常用于根据 L5 横突与骶骨之间的接触程度对 LSTV 进行分级。LSTV 给治疗医生带来了诊断上的难题，因为它们在普通 X 光片上甚至高级影像学检查中可能无法被识别；此外，即使发现了这种畸形，LSTV 患者可能无症状或仅有非特异性症状，如腰痛伴或不伴神经根症状。由于腰痛在普通人群中非常普遍；因此，很难将 LSTV 作为疼痛的来源。然而，对于 30 岁以下持续腰痛的患者，应谨慎排除贝氏综合征，因为它是先天性的。如果发现 LSTV，通常需要进行腰骶部 MRI 或 CT 扫描，如果没有更具说服力或明显的症状来源，建议采用保守的逐步管理计划。这可能包括在进行手术干预之前，通过注射评估症状是否有所改善。LSTV 在相邻脊柱水平引起的生物力学改变也会引起额外的关注，使这些患者更容易快速发生相邻节段疾病，这就提出了一个问题，即最适当的手术（切除 LSTV 假性关节或融合）。接受手术治疗的患者的术后结果数据在文献中有限，结果有希望但各不相同。必须进行更多大规模、对照研究，以进一步深入了解这种病理的理想检查和管理。
