Gabriel Daniel C, Liu David S, Ang Bryan, Hines Kristen E, Prabhat Anjali M, Hogue Grant D
From the Harvard Medical School, Boston, MA (Gabriel, Hines, and Prabhat); the Lenox Hill Hospital, New York, NY (Dr. Ang); and the Boston Children's Hospital, Department of Orthopedic Surgery, Boston, MA (Dr. Liu and Dr. Hogue).
J Am Acad Orthop Surg Glob Res Rev. 2025 Sep 3;9(9). doi: 10.5435/JAAOSGlobal-D-25-00069. eCollection 2025 Sep 1.
The purpose of this study was to develop a comprehensive step-wise management algorithm for Bertolotti syndrome in the pediatric population by conducting a systematic review of the current literature regarding the diagnostic evaluation, nonsurgical and surgical treatment, and outcomes.
A systematic review of the literature was conducted using PubMed to identify studies focused on the management of Bertolotti syndrome in the pediatric population. Data extraction of clinical presentation, management strategies, imaging, and outcomes was completed.
Thirteen studies reported on 17 patients younger than 18 years with confirmed diagnosis of Bertolotti syndrome were identified. Lower back pain was the most common presenting symptom and was described in all 13 studies. Radicular pain was described in six of 13 studies. Diagnostic, intraoperative, and postoperative assessments included preoperative radiographs, CT, MRI, along with targeted injections. Treatment options ranged from nonsurgical to surgical measures. Conservative options included physical therapy, nonsteroidal anti-inflammatory medications, bracing treatment, and targeted injections. Surgical modalities included open surgical resection and posterior spinal fusion. All patients in the 13 studies demonstrated partial or complete resolution of their presenting symptoms.
This study provides a proposed systemic algorithm for the management of Bertolotti syndrome in the pediatric population. Based on our review of the current literature, we recommend a stepwise approach to the management of Bertolotti syndrome starting from conservative options and progressing toward surgical treatment if symptoms persist.
本研究的目的是通过对当前有关诊断评估、非手术和手术治疗及结果的文献进行系统综述，为儿童人群的贝托洛蒂综合征制定一套全面的逐步管理算法。
使用PubMed对文献进行系统综述，以确定专注于儿童人群贝托洛蒂综合征管理的研究。完成了临床表现、管理策略、影像学和结果的数据提取。
确定了13项研究，报告了17例年龄小于18岁且确诊为贝托洛蒂综合征的患者。下背部疼痛是最常见的症状，所有13项研究均有描述。13项研究中有6项描述了神经根性疼痛。诊断、术中及术后评估包括术前X线片、CT、MRI以及靶向注射。治疗选择范围从非手术到手术措施。保守选择包括物理治疗、非甾体抗炎药、支具治疗和靶向注射。手术方式包括开放手术切除和后路脊柱融合术。13项研究中的所有患者均表现出其主要症状部分或完全缓解。
本研究为儿童人群贝托洛蒂综合征的管理提供了一种建议的系统算法。基于我们对当前文献的综述，我们建议对贝托洛蒂综合征采用逐步管理方法，从保守选择开始，如果症状持续则进展至手术治疗。
