Case study 44 - Bertolotti's syndrome - DIAGNOSIS and TREATMENT explained by a neurosurgeon скачать в хорошем качестве

Case study 44 - Bertolotti's syndrome - DIAGNOSIS and TREATMENT explained by a neurosurgeon

Case study 44 - Bertolotti’s Syndrome is defined as chronic back pain caused by transitional lumbosacral vertebra. The transitional vertebra may present with numerous clinical manifestations leading to a myriad of associated pain types. The most common is pain in the sacroiliac joint, groin, and hip region and may or may not be associated with radiculopathy. Diagnosis is made through a combination of clinical presentations and imaging studies and falls into one of four types. The incidence of transitional vertebra has a reported incidence between 4 and 36%; however, Bertolotti’s Syndrome is only diagnosed when the cause of pain is attributed to this transitional anatomy. Therefore, the actual incidence is difficult to determine. Initial management with conservative treatment includes medical management and physical therapy. Injection therapy has been established as an effective second line. Epidural steroid injection at the level of the transitional articulation is effective, with either local anesthetics alone or in combination with steroids. Surgery carries higher risks and is reserved for patients failing previous lines of treatment. Options include surgical removal of the transitional segment, decompression of stenosed foramina, and spinal fusion. Recent evidence suggests that radiofrequency ablation (RFA) around the transitional segment may also provide relief. There are surgical options to treat Bertolotti’s Syndrome. Although an effective method of treatment when indicated, there are inherent risks with surgery. One of the most common forms of treatment is resection, also known as the “Processectomy,” of the lumbosacral transitional vertebra. This surgery addresses back pain in a patient with LSTV related to the mechanical stress of the pseudo articulation or the articulation. A spine fusion is a surgical procedure that helps relieve the chronic pain caused by Bertolotti’s Syndrome. A study by Santavirta followed eight patients who underwent a resection of the transverse process and eight who underwent a posterolateral fusion. When comparing the long-term outcomes, the fusion cohort had an increased disc degeneration in the disc immediately superior to the fusion, with 7 of 8 patients showing degeneration at follow-up. However, patients with previous disc degeneration of the LSTV disc, but not the superior disc, fared better with the fusion than the resection. As such, it is recommended that fusion be considered on selected patients who have previous disc pathology. #neurosurgery #neurosurgeon #casestudy #bertolottissyndrome #bertolottis #learnonyoutube #surgery #spinesurgery #backpain #backsurgery #spinalstenosis #ladyspinedoc