Kawasaki Toshinari, Maki Yoshinori, Ioroi Yoshihiko, Kobayashi Tamaki, Takayama Motohiro
Department of Spinal Neurosurgery, Kyoto Katsura Hospital, Kyoto, Japan.
Department of Neurosurgery, Hikone Chuo Hospital, Hikone, Shiga, Japan.
J Neurosurg Case Lessons. 2025 Jul 21;10(3). doi: 10.3171/CASE25188.
Bertolotti's syndrome (BS) is characterized by anomalous enlargement of the transverse process (TP) of the most caudal lumbar vertebra, which may articulate or fuse with the sacrum or ilium.
A 69-year-old female presented to the hospital with a chief complaint of right low back pain (LBP) during rolling over, while crouching down, and with prolonged sitting. No obvious neurological abnormality was found. Radiography and CT findings revealed that the right TP of L5 articulated with the iliac bone. The patient's pain was resistant to conservative treatment with appropriate nonsteroidal anti-inflammatory drugs over a period of approximately 9 months. A local anesthetic injection into the articulated lesion under fluoroscopic guidance led to LBP improvement, but the effect was transient. Full endoscopic spine surgery (FESS) was performed to reduce the enlargement of the TP articulated with the ilium under fluoroscopy. Postoperative CT revealed the disconnection between the TP at L5 and the ilium. LBP dramatically resolved postoperatively, and the patient was discharged home without any perioperative complications.
FESS may be an effective treatment for patients with LBP due to minimally invasive BS. https://thejns.org/doi/10.3171/CASE25188.
贝托洛蒂综合征（BS）的特征是最尾侧腰椎横突（TP）异常增大，其可能与骶骨或髂骨相连或融合。
一名69岁女性因翻身、蹲下及长时间坐位时出现右下腹疼痛（LBP）为主诉入院。未发现明显神经异常。X线和CT检查结果显示L5右侧横突与髂骨相连。患者疼痛在约9个月期间对适当的非甾体抗炎药保守治疗无效。在透视引导下向关节病变处注射局部麻醉剂可使LBP改善，但效果是暂时的。进行了全内镜脊柱手术（FESS）以在透视下减少与髂骨相连的横突增大。术后CT显示L5横突与髂骨分离。术后LBP显著缓解，患者出院时无任何围手术期并发症。
FESS可能是治疗因微创性BS导致LBP患者的有效方法。https://thejns.org/doi/10.3171/CASE25188 。
