Bertolotti syndrome (lumbosacral transitional vertebrae)
Diagnosis certain
Updates to Case Attributes
Title
was changed:
Bertolotti syndrome(lumbosacral transistionaltransitional vertebrae)
Age
changed from 27 to 25 years.
Presentation
was changed:
Vague pain over the left gluteal region.
Body
was changed:
Bertolotti syndrome is a developmental abnormality wherein, the transverse process of the caudal most lumbar vertebrae is enlarged and shows pseudo articulationpseudoarticulation with the sacral ala or ilium, leading to an uncommon cause of chronic lower back and gluteal region pain in young individuals.
Radiologists mustshould try to interpretrecognise this condition, particularly regarding pseudoarticulation, as there is potential clinical significance due to the following explanationfactors:
1. The pseudo-articulation
-
pseudoarticulation causes biomechanical stress - reduces mobility on the ipsilateral side
andor alternativelycausecauses hypermobility on the contralateral side, leading to pain.2. Ipsilateral -
ipsilateral facetal arthropathy
.3. Iliopsoas -
iliopsoas and quadratus lumborum
mechanicalmuscle strain.4. Narrowed -
narrowed neural foramina by the dysplastic transverse process, causing nerve root compression
.5. Disc -
disc herniation above the level of transitional vertebra
.6. Pseudoarticulation -
pseudoarticulation may lead to a stress reaction, seen as
edemaoedema or sclerosis.
Apart from the above, identifying transitional vertebrae may prevent incorrect surgery level.
Special thanks: to Dr HT Gururaj H T.
-<p>Bertolotti syndrome is a developmental abnormality wherein, the transverse process of the caudal most lumbar vertebrae is enlarged and shows pseudo articulation with sacral ala or ilium, leading to an uncommon cause of chronic lower back and gluteal region pain in young individuals.</p><p>Radiologists must try to interpret this condition, particularly regarding pseudoarticulation, as there is clinical significance due to the following explanation:</p><p>1. The pseudo-articulation causes biomechanical stress - reduces mobility on the ipsilateral side and alternatively cause hypermobility on the contralateral side, leading to pain.</p><p>2. Ipsilateral facetal arthropathy.</p><p>3. Iliopsoas and quadratus lumborum mechanical strain.</p><p>4. Narrowed neural foramina by the dysplastic transverse process, causing nerve root compression .</p><p>5. Disc herniation above the level of transitional vertebra.</p><p>6. Pseudoarticulation may lead to a stress reaction, seen as edema or sclerosis.</p><p>Apart from the above, identifying transitional vertebrae may prevent incorrect surgery level.</p><p>Special thanks: Dr Gururaj H T.</p>- +<p>Bertolotti syndrome is a developmental abnormality wherein, the transverse process of the caudal most lumbar vertebrae is enlarged and shows pseudoarticulation with the sacral ala or ilium, leading to an uncommon cause of chronic lower back and gluteal region pain in young individuals.</p><p>Radiologists should try to recognise this condition, particularly regarding pseudoarticulation, as there is potential clinical significance due to the following factors:</p><ul>
- +<li>pseudoarticulation causes biomechanical stress - reduces mobility on the ipsilateral side or alternatively causes hypermobility on the contralateral side, leading to pain</li>
- +<li>ipsilateral facetal arthropathy</li>
- +<li>iliopsoas and quadratus lumborum muscle strain</li>
- +<li>narrowed neural foramina by the dysplastic transverse process, causing nerve root compression</li>
- +<li>disc herniation above the level of transitional vertebra</li>
- +<li>pseudoarticulation may lead to a stress reaction, seen as oedema or sclerosis</li>
- +</ul><p>Apart from the above, identifying transitional vertebrae may prevent incorrect surgery.</p><p>Special thanks to Dr HT Gururaj</p>
References changed:
- 1. Avimadj M, et al. Can an Anomalous Lumbosacral or Lumboiliac Articulation cause Low Back pain? A Retrospective Study of 12 Cases. Rev Rhum Engl Ed 1999; 66:35-39.
- 2. Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976) 1984;9:493–495.
- 3. Brohn JL, van Royen BJ, Wuisman P. The Clinical Significance of Lumbosacral Transitional Anomalies. Acta Orthop Belg, 2007,73: 687-695.
- 4. Bertolotti M: Contributo alla conoscenza dei vizi differenza-zione regionale del rachide con speciale riguardo all assimilazione sacrale della V. lombare. Radiol Med 1917, 4:113-144.
- Avimadj M, et al. Can an Anomalous Lumbosacral or Lumboiliac Articulation cause Low Back pain? A Retrospective Study of 12 Cases. Rev Rhum Engl Ed 1999; 66:35-39.
- Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976) 1984;9:493–495.
- Brohn JL, van Royen BJ, Wuisman P. The Clinical Significance of Lumbosacral Transitional Anomalies. Acta Orthop Belg, 2007,73: 687-695.
- Bertolotti M: Contributo alla conoscenza dei vizi differenza-zione regionale del rachide con speciale riguardo all assimilazione sacrale della V. lombare. Radiol Med 1917, 4:113-144.
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Findings
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The left transverse process of L5 appears to beis enlarged and dyplasticdysplastic (mega apophysis-apophysis). This transverse process is seen to articulate with its ipsilateral sacral ala, suggestive of pseudoarthrosispseudoarthrosis. Features suggest a type II a lumboscarallumbosacral transitional vertebraevertebra.
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