Desai Ansh, McGrath Kyle, Rao Elizabeth M, Thompson Nicolas R, Schmidt Eric, Lee Jonathan, Statsevych Volodymyr, Steinmetz Michael P
1Center for Spine Health, Neurologic Institute, Cleveland Clinic, Cleveland.
2Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati.
J Neurosurg Spine. 2023 Mar 17:1-8. doi: 10.3171/2023.2.SPINE221071.
Bertolotti syndrome is a clinical diagnosis given to patients with low-back pain arising from a lumbosacral transitional vertebra (LSTV). While biomechanical studies have demonstrated abnormal torques and range of motion occurring at and above this type of LSTV, the long-term effects of these biomechanical changes on the LSTV adjacent segments are not well understood. This study examined degenerative changes at segments superjacent to the LSTV in patients with Bertolotti syndrome.
This study involved a retrospective comparison of patients between 2010 and 2020 with an LSTV and chronic back pain (Bertolotti syndrome) and control patients with chronic back pain with no LSTV. The presence of an LSTV was confirmed on imaging, and the caudal-most mobile segment above the LSTV was assessed for degenerative changes. Degenerative changes were assessed by grading the intervertebral disc, facets, degree of spinal stenosis, and spondylolisthesis using well documented grading systems. All computations were performed in R, version 4.1.0. All tests were two-sided, and p values < 0.05 was considered statistically significant. Separate logistic regression analyses were run with the associated dependent variables for each aim, with age at MRI and sex included as covariates. Odds ratios and 95% confidence intervals were computed.
A total of 172 patients were included, 101 with Bertolotti syndrome and 71 controls. Control patients consisted of patients with low-back pain but no diagnosis of Bertolotti syndrome or an LSTV. Fifty-six Bertolotti (55.4%) and 27 control (38.0%) patients were female, (p = 0.03). After adjusting for age at MRI and sex, Bertolotti patients had pelvic incidence (PI) that was 9.83° greater than control patients (95% CI 5.15°-14.50°, p < 0.001). Sacral slope was not significantly different between the Bertolotti and control groups (beta estimate 3.10°, 95% CI -1.07° to 7.27°; p = 0.14). Bertolotti patients had 2.69 times higher odds of having a high disc grade at L4-5 (3-4 vs 0-2), compared with control patients (OR 2.69, 95% CI 1.28-5.90; p = 0.01). There were no significant differences between Bertolotti patients and controls for spondylolisthesis, facet grade, or spinal stenosis grade.
Patients with Bertolotti syndrome had a significantly higher PI and were more likely to have adjacent-segment disease (ASD; L4-5) compared with control patients. However, after controlling for age and sex, PI and ASD did not appear to have a significant association within the cohort of Bertolotti patients. The altered biomechanics and kinematics in this condition may be a causative factor in this degeneration, although proof of causation is not possible in this study. This association may warrant closer follow-up protocols for patients being treated for Bertolotti syndrome, but further prospective studies are needed to establish if radiographic parameters can serve as an indicator for biomechanical alterations in vivo.
博托洛蒂综合征是一种针对因腰骶部移行椎（LSTV）引发下腰痛患者的临床诊断。虽然生物力学研究已证明在这类LSTV及其上方会出现异常扭矩和活动范围，但这些生物力学变化对LSTV相邻节段的长期影响尚不清楚。本研究调查了博托洛蒂综合征患者中LSTV上方节段的退变情况。
本研究对2010年至2020年间患有LSTV和慢性背痛（博托洛蒂综合征）的患者与无LSTV的慢性背痛对照患者进行了回顾性比较。通过影像学检查确认LSTV的存在，并对LSTV上方最尾端的可活动节段进行退变情况评估。使用记录完善的分级系统，通过对椎间盘、小关节、椎管狭窄程度和椎体滑脱进行分级来评估退变情况。所有计算均在R 4.1.0版本中进行。所有检验均为双侧检验，p值<0.05被认为具有统计学意义。针对每个目标，分别进行逻辑回归分析，将MRI检查时的年龄和性别作为协变量纳入。计算优势比和95%置信区间。
共纳入172例患者，其中101例患有博托洛蒂综合征，71例为对照患者。对照患者为患有下腰痛但未诊断为博托洛蒂综合征或LSTV的患者。56例博托洛蒂综合征患者（55.4%）和27例对照患者（38.0%）为女性（p = 0.03）。在对MRI检查时的年龄和性别进行调整后，博托洛蒂综合征患者的骨盆入射角（PI）比对照患者大9.83°（95%置信区间5.15° - 14.50°，p < 0.001）。博托洛蒂综合征组和对照组之间的骶骨斜率无显著差异（β估计值3.10°，95%置信区间 - 1.07°至7.27°；p = 0.14）。与对照患者相比，博托洛蒂综合征患者L4 - 5节段椎间盘分级较高（3 - 4级 vs 0 - 2级）的几率高2.69倍（优势比2.69，95%置信区间1.28 - 5.90；p = 0.01）。在椎体滑脱、小关节分级或椎管狭窄分级方面，博托洛蒂综合征患者与对照患者之间无显著差异。
与对照患者相比，博托洛蒂综合征患者的PI显著更高，且更易发生相邻节段疾病（ASD；L4 - 5）。然而，在控制年龄和性别后，PI和ASD在博托洛蒂综合征患者队列中似乎没有显著关联。尽管本研究无法证明因果关系，但这种情况下生物力学和运动学的改变可能是这种退变的一个致病因素。这种关联可能需要对接受博托洛蒂综合征治疗的患者制定更密切的随访方案，但需要进一步的前瞻性研究来确定影像学参数是否可作为体内生物力学改变的指标。
