Bertolotti’s Syndrome: A Rare Case of Low Backache | Chapter 1 | Medical Research and Its Applications Vol. 5

Bertolotti’s syndrome was first described in 1971 and is characterized by an abnormal enlargement of the transverse process of the most caudal lumber vertebra i.e. L5. The Lumbosacral transition of the L5 vertebra is an anatomical variation. An enlarged transverse process of the L5 vertebra may form a pseudo joint with the ilium or sacrum. This may lead to low back pain, especially in young adults due to changes in biomechanical properties of the lumber spine. This condition is referred to as Bertolotti’s syndrome.

We present the case of a 40-year-old male surgeon with low backache not responding to oral and intravenous pain killers which prevented him from carrying out his daily routine activities. The pain was severe, excruciating and radiating to the right buttock with a Visual Analogue Scale (VAS) score ranging from 8/10. There was tenderness over the right sacroiliac area provoked by deep palpation. A provisional diagnosis of right sacroilitis was made. Fluoroscopy revealed anomalous articulation between the right enlarged L5 transverse process with ipsilateral ala of sacrum forming a pseudo arthrosis with maximum tenderness over it. A radiograph of the lumbar spine revealed a typical lumbosacral transition of the L5 vertebra with a large L5 transverse process articulating with ala of the sacrum. Periarticular injection at the pseudo joint with 0.1 % bupivacaine and triamcinolone 40 mg was given under fluoroscope and confirmed with dye. There was immediate relief from pain. In young individuals with chronic low back pain diagnosis of Bertolotti’s syndrome should also be kept in mind. In our case infiltration of local anesthetic and steroids into the pseudoarthrosis under fluoroscope guidance resulted in the resolution of the symptoms.

 

Author(s)details:-

 

Liaquat Ali
Department of Anesthesiology, Critical Care and Pain Medicine, Clinical skill lab, Foundation University School of Health Sciences/Foundation University Islamabad, Fauji Foundation Hospital, Rawalpindi, Pakistan.

 

Sana Nasir
Department of Anesthesiology, Critical Care and Pain Medicine Foundation University School of Health Sciences/ Foundation University Islamabad, Fauji Foundation Hospital, Rawalpindi, Pakistan.

 

Umer Ali
Department of Anesthesiology, Critical Care and Pain Medicine, Clinical skill lab, Foundation University School of Health Sciences/Foundation University Islamabad, Fauji Foundation Hospital, Rawalpindi, Pakistan.

Khaleel Ahmed
Department of Anesthesiology, Critical Care and Pain Medicine, Clinical skill lab, Foundation University School of Health Sciences/Foundation University Islamabad, Fauji Foundation Hospital, Rawalpindi, Pakistan.

 

Please See the book here :- https://doi.org/10.9734/bpi/mria/v5/2226G