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.
BMC Surg. 2022 Feb 2;22(1):36. doi: 10.1186/s12893-022-01498-y.
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.
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.
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.
Bertolotti 综合征（BS）的特征为下腰椎横突增大，导致慢性持续性腰痛或坐骨神经痛。本研究旨在描述治疗 BS 的手术技术，并回顾现有文献中描述的不满意结果。
我们报告了 1 例患者，其主要诉腰痛和酸痛，10 多年来间歇性放射至左腿。根据症状和体征的检查，包括影像学和电生理学评估，以及对诊断触发点（横突与骶骨翼或髂嵴之间的关节）局部类固醇注射后暂时缓解疼痛的报告，该患者被诊断为 BS。应用的手术技术包括微创、三维 C 臂引导、管腔入路以及显微镜和骨 cavitron 超声外科吸引器辅助操作。术后 3 天，患者的视觉模拟评分（从 10 分制的 8 分降至 2 分）和左腿直腿抬高试验（从 20°增加至 90°）均有改善。患者术后一周内恢复了正常生活并重返工作岗位，未观察到术后并发症。
微创管状显微镜减压和解离是治疗 BS 的有效方法。然而，为了获得成功的结果，建议使用符合患者诊断的医生熟练的技术。
