Chung Richard J, Harvie Camryn, O'Donnell John, Jenkins Sarah, Jenkins Arthur L
1Jenkins NeuroSpine, New York, New York; and.
Departments of2Neurosurgery and.
J Neurosurg Case Lessons. 2023 Feb 13;5(7). doi: 10.3171/CASE22450.
Bertolotti's syndrome is a condition of the lower back and/or L5 distribution leg pain caused by a lumbosacral transitional vertebra (LSTV). Diagnosing the LSTV as the cause of the symptoms and condition is essential for accurate management of this syndrome. Castellvi's classification system is widely accepted for LSTV anatomy, but it measures only one aspect of transitional anatomy and was intended primarily to identify target-level disk herniations.
In this case, the Castellvi classification system failed to identify the patient (with 2 years of back and L5 pain) as having an LSTV, even though he displayed LSTV-like anatomy because both L5 transverse process heights measured less than 19 mm. He attained brief but significant relief from bilateral injections into the L5-S1 transverse/ala region and underwent a minimally invasive bilateral decompression of L5-S1 with almost complete relief of his symptoms maintained more than 6 months postoperatively.
Given that the patient gained significant relief from treatment of transitional anatomy that failed to be identified using Castellvi's classification system, this case suggests that transverse process height may not be adequate or even the most clinically relevant indicator in identifying LSTV anatomy, which is a precursor to the diagnosis of Bertolotti's syndrome.
贝托洛蒂综合征是一种由腰骶部移行椎（LSTV）引起的下背部和/或L5分布区腿部疼痛的病症。将LSTV诊断为症状和病症的病因对于准确管理该综合征至关重要。卡斯特尔维分类系统被广泛用于LSTV的解剖学，但它仅测量了移行解剖学的一个方面，并且主要旨在识别目标节段的椎间盘突出。
在该病例中，卡斯特尔维分类系统未能将该患者（有2年的背部和L5疼痛）诊断为患有LSTV，尽管他表现出类似LSTV的解剖结构，因为两个L5横突高度均小于19毫米。他通过双侧注射L5-S1横突/翼区域获得了短暂但显著的缓解，并接受了L5-S1双侧微创减压术，术后症状几乎完全缓解并持续了6个月以上。
鉴于该患者通过治疗未能用卡斯特尔维分类系统识别的移行解剖结构而获得了显著缓解，该病例表明横突高度可能不足以甚至不是识别LSTV解剖结构的最具临床相关性的指标，而LSTV解剖结构是贝托洛蒂综合征诊断的先兆。
