Bertolotti综合征指的是因腰骶移行椎横突单侧或双侧异常增大所导致的一系列症状与体征,患者常表现出腰骶部疼痛及下肢放射痛等,该病在临床上发病率较低,常被误诊。一般采用X线检查对Bertolotti综合征进行诊断,不过随着技术的进步,多层...Bertolotti综合征指的是因腰骶移行椎横突单侧或双侧异常增大所导致的一系列症状与体征,患者常表现出腰骶部疼痛及下肢放射痛等,该病在临床上发病率较低,常被误诊。一般采用X线检查对Bertolotti综合征进行诊断,不过随着技术的进步,多层螺旋CT的多平面重建与容积再现技术在诊断Bertolotti综合征中展现出显著优势。对于Bertolotti综合征,传统的治疗手段如药物镇痛及局部阻滞等在实际应用中效果有限,现阶段手术治疗则涵盖肥大横突切除术、融合术及单侧双通道内镜下的神经根管减压术等,均具有较好的效果。不过部分手术创伤大、并发症多、复发率高,而椎间盘镜手术、单侧双通道内镜下神经根管减压术以及联合疗法成为治疗Bertolotti综合征的更优选择。Bertolotti syndrome refers to a series of symptoms and signs caused by unilateral or bilateral abnormal enlargement of the transverse processes of the lumbosacral transitional vertebra. Patients often present with lumbosacral pain and radiating pain in the lower limbs. The disease has a relatively low clinical incidence and is frequently misdiagnosed. X-ray examination is generally used for the diagnosis of Bertolotti syndrome. However, with technological advancements, multiplanar reconstruction and volume rendering techniques of multi-slice spiral CT have demonstrated significant advantages in diagnosing Bertolotti syndrome. For Bertolotti syndrome, traditional treatment methods such as pharmacological analgesia and local nerve blocks have limited efficacy in practical applications. At present, surgical treatments, including resection of the enlarged transverse process, fusion surgery, and unilateral biportal endoscopic nerve root canal decompression, have shown favorable outcomes. Nevertheless, some surgical procedures are associated with significant trauma, a high incidence of complications, and a high recurrence rate. Consequently, procedures such as microendoscopic discectomy, unilateral biportal endoscopic nerve root canal decompression, and combination therapies have emerged as superior options for treating Bertolotti syndrome.展开更多
Background: Mario Bertolotti, (1917) described LSTV-Lumbar spinal transitional vertebra as Bertolotti Syndrome a century ago and associated low back pain with it. Yet, it needs to be given significance in general orth...Background: Mario Bertolotti, (1917) described LSTV-Lumbar spinal transitional vertebra as Bertolotti Syndrome a century ago and associated low back pain with it. Yet, it needs to be given significance in general orthopaedic practice even now, and radiologists underreport it. LSTV is a congenital anatomical anomaly that Castellvi classified into four varying types. Purpose: I titled this phenomenon “Kiran Nandivada’s stuck blade in a grinder jar degenerative cascade by LSTV at L5-S1” to clearly explain how an abnormal mega-transverse apophysis with its various variations affects the weight-bearing mechanics as the L5-S1 which is a vital junction where the maximum body weight is directed into both the sacroiliac joints and if a transitional vertebra occurs it becomes detrimental and abnormally redirects the load-bearing forces and leads to a progressive degenerative cascade both proximally and distally. As the L5 vertebral rotations and other movements of flexion, extensions, lateral flexion are stuck like a bent grinder blade, the other areas of the region are damaged progressively as the pelvis, just like the grinder motor tries to move it, resulting in overheating and maybe even a burnout results in the form of facet arthritis, disc degeneration in the normal disc above, the transitional disc at L5-S1, foraminal osteophytes causing radiculopathy, sacroiliac joint arthritis. Material and Methods: Around 200 X-rays of children and adults with this congenital anomaly have been studied between 2020 and 2023. This is a retrospective study. Results: 1) Our study showed an Increased incidence of LSTV at 15%. 2) Patients ranged from asymptomatic, atypical lumbago to classical lumbago with sciatica and claudication. Findings supported facet and sacroiliac joint arthritis and the pain, relieved with physiotherapy, posture corrections, weight reduction, and lifestyle precautions, negating the need for local steroid injections, radiofrequency ablation or surgical excision as per our experience. Conclusion: Other dysplastic congenital manifestations like associated scoliosis, facet tropism and nerve root, and sacroiliac joint anomalies can co-exist. These radiological findings must be clearly explained to the patient so that the inherently progressive nature of this phenomenon is well understood and the patient can take the required precautions to slow them and suitable conservative treatment can be planned. In rare cases, radiofrequency ablation or even rarely a surgical resection could be beneficial, but the surgical approach could be complex as normal anatomy is changed. Hence, prior anaesthesia blocks and even scintigraphy are essential steps to clearly define and confirm the LSTV to be the actual cause of the pain.展开更多
文摘Bertolotti综合征指的是因腰骶移行椎横突单侧或双侧异常增大所导致的一系列症状与体征,患者常表现出腰骶部疼痛及下肢放射痛等,该病在临床上发病率较低,常被误诊。一般采用X线检查对Bertolotti综合征进行诊断,不过随着技术的进步,多层螺旋CT的多平面重建与容积再现技术在诊断Bertolotti综合征中展现出显著优势。对于Bertolotti综合征,传统的治疗手段如药物镇痛及局部阻滞等在实际应用中效果有限,现阶段手术治疗则涵盖肥大横突切除术、融合术及单侧双通道内镜下的神经根管减压术等,均具有较好的效果。不过部分手术创伤大、并发症多、复发率高,而椎间盘镜手术、单侧双通道内镜下神经根管减压术以及联合疗法成为治疗Bertolotti综合征的更优选择。Bertolotti syndrome refers to a series of symptoms and signs caused by unilateral or bilateral abnormal enlargement of the transverse processes of the lumbosacral transitional vertebra. Patients often present with lumbosacral pain and radiating pain in the lower limbs. The disease has a relatively low clinical incidence and is frequently misdiagnosed. X-ray examination is generally used for the diagnosis of Bertolotti syndrome. However, with technological advancements, multiplanar reconstruction and volume rendering techniques of multi-slice spiral CT have demonstrated significant advantages in diagnosing Bertolotti syndrome. For Bertolotti syndrome, traditional treatment methods such as pharmacological analgesia and local nerve blocks have limited efficacy in practical applications. At present, surgical treatments, including resection of the enlarged transverse process, fusion surgery, and unilateral biportal endoscopic nerve root canal decompression, have shown favorable outcomes. Nevertheless, some surgical procedures are associated with significant trauma, a high incidence of complications, and a high recurrence rate. Consequently, procedures such as microendoscopic discectomy, unilateral biportal endoscopic nerve root canal decompression, and combination therapies have emerged as superior options for treating Bertolotti syndrome.
文摘Background: Mario Bertolotti, (1917) described LSTV-Lumbar spinal transitional vertebra as Bertolotti Syndrome a century ago and associated low back pain with it. Yet, it needs to be given significance in general orthopaedic practice even now, and radiologists underreport it. LSTV is a congenital anatomical anomaly that Castellvi classified into four varying types. Purpose: I titled this phenomenon “Kiran Nandivada’s stuck blade in a grinder jar degenerative cascade by LSTV at L5-S1” to clearly explain how an abnormal mega-transverse apophysis with its various variations affects the weight-bearing mechanics as the L5-S1 which is a vital junction where the maximum body weight is directed into both the sacroiliac joints and if a transitional vertebra occurs it becomes detrimental and abnormally redirects the load-bearing forces and leads to a progressive degenerative cascade both proximally and distally. As the L5 vertebral rotations and other movements of flexion, extensions, lateral flexion are stuck like a bent grinder blade, the other areas of the region are damaged progressively as the pelvis, just like the grinder motor tries to move it, resulting in overheating and maybe even a burnout results in the form of facet arthritis, disc degeneration in the normal disc above, the transitional disc at L5-S1, foraminal osteophytes causing radiculopathy, sacroiliac joint arthritis. Material and Methods: Around 200 X-rays of children and adults with this congenital anomaly have been studied between 2020 and 2023. This is a retrospective study. Results: 1) Our study showed an Increased incidence of LSTV at 15%. 2) Patients ranged from asymptomatic, atypical lumbago to classical lumbago with sciatica and claudication. Findings supported facet and sacroiliac joint arthritis and the pain, relieved with physiotherapy, posture corrections, weight reduction, and lifestyle precautions, negating the need for local steroid injections, radiofrequency ablation or surgical excision as per our experience. Conclusion: Other dysplastic congenital manifestations like associated scoliosis, facet tropism and nerve root, and sacroiliac joint anomalies can co-exist. These radiological findings must be clearly explained to the patient so that the inherently progressive nature of this phenomenon is well understood and the patient can take the required precautions to slow them and suitable conservative treatment can be planned. In rare cases, radiofrequency ablation or even rarely a surgical resection could be beneficial, but the surgical approach could be complex as normal anatomy is changed. Hence, prior anaesthesia blocks and even scintigraphy are essential steps to clearly define and confirm the LSTV to be the actual cause of the pain.
