![]() ![]() described 7 patients who underwent minimally invasive paramedian tubular-based resection of anomalous transverse processes 5 (71%) of these patients experienced either complete or partial resolution of pain after surgery. Anterior and posterior approaches have been reported in the literature with the latter being most commonly employed (including in the present cases). Surgical management involves excision of the pseudoarthrosis either alone or in combination with an interbody fusion. Plain anterior and posterior radiographs, CT, and MRI are useful in visualizing the pathology and ruling out other causes of LBP. The most common symptoms of Bertolotti's syndrome include chronic LBP with or without radiculopathy. reviewed 35 patients with Bertolotti's syndrome and reported a mean age of 32.7 years (range: 15 to 60 years). The incidence ranges from 4% to 15% and the prevalence is between 4% and 36%. At 6 and 9 months, respectively, both patients were asymptomatic.īertolotti's syndrome was first described in 1917 by Italian physician Mario Bertolotti. Adequate resection of the anomalous transverse process was confirmed with the O-Arm. A high-speed drill was used to resect the L5 transverse process up to its junction with the vertebral body. Under the operating microscope, the transverse processes and adjacent muscular and ligamentous attachments were carefully removed to expose the sacral ala. ![]() A paramedian vertical incision was made over the posterior superior iliac spine and the anomalous transverse process was exposed. The O-arm was used to localize the L5-S1 transitional segment. The spinous process of L4 was exposed and a navigation clamp was placed. The L5–S1 level was identified by sterile palpation and a 2-cm midline incision was made down to the thoracolumbar fascia. Preoperative O-arm ® (3D CT) images were obtained from the superior endplate of L4 to the sacrococcygeal joint to clearly delineate the L5–S1 intervertebral space. The patients were positioned prone on a Jackson table. Keywords: Bertolotti's syndrome, pseudoarticulation, sacrum, transverse process Excellent outcomes were achieved in both patients. Both patients experienced immediate pain resolution (documented on the postoperative notes) and remained asymptomatic 1 year later.Ĭonclusion:Intraoperative three-dimensional imaging and navigation guidance facilitated the resection of anomalous transverse processes in two patients with Bertolotti's syndrome. ![]() Thus, the patients subsequently underwent O-arm neuronavigational resection of the bony defects. Injections of the pseudoarticulations resulted in only temporary symptomatic relief. Imaging revealed lumbosacral transitional vertebrae at the level of L5-S1, which was consistent with Bertolotti's syndrome. The patients were 17- and 38-years-old, and presented with severe, chronic low back pain that was resistant to conservative treatment. Here, we describe the use of intraoperative three-dimensional image-guided navigation in the resection of anomalous transverse processes in two patients with Bertolotti's syndrome.Ĭase Descriptions:Two patients diagnosed with Bertolotti's syndrome who had undergone the above-mentioned procedure were identified. Background:Bertolotti's syndrome is characterized by enlargement of the transverse process at the most caudal lumbar vertebra with a pseudoarticulation between the transverse process and sacral ala. ![]()
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