Features of clinical manifestations, diagnosis and treatment of Bertolotti syndrome: а clinical case

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Abstract

BACKGROUND: One of the causes of pain in the lumbar spine may be congenital spinal column malformations. Bertolotti syndrome is a clinical and radiological symptom complex associated with sacralization of the LV vertebra, leading to disruption of the biomechanics of the lumbosacral spine and accelerated degeneration of facet joints and intervertebral discs, followed by foraminal and central stenosis of the spinal canal. The clinical manifestations of the disease can be polymorphic, and their cause is multifactorial. Thus, along with pain in the lumbar spine, patients with sacralization of the LV vertebra suffer from numbness and paresthesia in the lower extremities. The incidence of pathology ranges from 4% to 8%, mainly affecting elderly and mature people.

СLINICAL CASE DESCRIPTION: Patient S was born in 1982 with long-term nonspecific pain in the back and lower limb; she presented to the Neurosurgical Department of the Irkutsk Scientific Center for Surgery and Traumatology. During a clinical neurological examination and additional introscopic studies of the lumbar spine, dorsopathy diagnosed. Degenerative spondyloarthrosis LIV–LV grade III according to D. Weishaupt. Sacralization of the LV vertebra type IIa according to Castellvi A.E. Syndrome of lumbar ischialgia on the right. Persistent pain and muscle-tonic syndrome. Minimally invasive interventional treatment was performed: pulsed radiofrequency ablation of the dorsal ganglion and radicular nerve at the level of the foraminal openings LIV–LV on the right and thermal radiofrequency ablation of the recurrent nerve of Luschka at the level of LIV–LV and LV–SI on the right. In the postoperative period, the intensity of the pain syndrome decreased, and the patient was discharged to work.

CONCLUSION: A promising method of minimally invasive surgery is radiofrequency ablation in the area of neoarthrosis for denervation and relief of pathological pain impulses. Assessing the patient’s complaints, carefully collecting anamnesis, interpreting data from a clinical and neurological examination, and introscopic methods of examining the lumbar spine enables establishing an accurate diagnosis and selecting the most effective treatment method.

About the authors

Oxana V. Sklyarenko

Irkutsk Scientific Center of Surgery and Traumatology

Email: oxanasklyarenko@mail.ru
ORCID iD: 0000-0003-1077-7369
SPIN-code: 7884-9030

MD, PhD

Russian Federation, Irkutsk

Sergey N. Larionov

Irkutsk Scientific Centre of Surgery and Traumatology

Email: snlar@mail.ru
ORCID iD: 0000-0001-9189-3323
SPIN-code: 6720-4117

MD, PhD, Professor

Russian Federation, Irkutsk

Alexandr P. Zhivotenko

Irkutsk Scientific Centre of Surgery and Traumatology

Author for correspondence.
Email: sivotenko1976@mail.ru
ORCID iD: 0000-0002-4032-8575
SPIN-code: 8016-5626

Junior Research Associate

Russian Federation, Irkutsk

Vitaly E. Potapov

Irkutsk Scientific Center of Surgery and Traumatology

Email: pva454@yandex.ru
ORCID iD: 0000-0001-9167-637X
SPIN-code: 5349-8690

MD, PhD

Russian Federation, Irkutsk

Anatoly V. Gorbunov

Irkutsk Scientific Center of Surgery and Traumatology

Email: a.v.gorbunov58@mail.ru
ORCID iD: 0000-0002-1352-0502
SPIN-code: 6329-2590

Junior Research Associate

Russian Federation, Irkutsk

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2. Fig. 1. Sacralization from a multispiral computer tomography scan: MSCT 3D front projection (а); MSCT 3D rear projection (б); MSCT reconstruction with a poly-projection scan (в). At the LV vertebra level, a lumbosacral junction anomaly is determined by the type of asymmetric right-sided sacralization of the LV vertebra with the formation of neoarthrosis between the massive transverse process and the lateral mass of the sacrum (white arrow). The body of the LIV vertebra is displaced ventrally by 0.45 cm (grade I antespondylolisthesis). Spondyloarthrosis LIV–LV III degree according to D. Weishaupt [14]. Sacralization of LV vertebra type IIa according to A.E. Castellvi [15]

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3. Fig. 2. Magnetic resonance imaging Т2-weighted image, frontal projection (а), sagittal projection (б), and axial projection (в); Т1-weighted image, sagittal projection (г). Neoarthrosis between the transverse process and lateral mass of the sacrum (white arrow). Compression of the spinal roots is not determined

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4. Fig. 3. Intraoperative radiographs: the electrode is installed at the level of the dorsal ganglion and radicular nerve in the projection of the LIV–LV foramen on the right, to verify the root, contrast with iohexol 300 was performed to perform pulsed radiofrequency ablation (а); the electrode is installed in the projection of the facet joint LIV–LV and LV–SI on the right in the projection of the Luschka nerve innervating the facet joint for thermal radiofrequency ablation (б) [16]

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5. Fig. 4. Lumbarization from a multispiral computer tomography scan: MSCT 3D front projection (а), MSCT 3D rear projection (б), and MSCT reconstruction with a projection scan at the LV–LVI level (в). Six lumbar vertebrae are shown. Left-sided scoliosis with curvature of the spine up to 170° with the apex of the arch on LIV. Hyperlordosis. The body of the LV vertebra is displaced ventrally by 0.46 cm (grade 1 antespondylolisthesis). Spondyloarthrosis LIV–LV, LV–LVI III degree according to D. Weishaupt [14]. Lumbarization from a magnetic resonance imaging, T2-weighted image: frontal projection (г), sagittal projection (д), and axial projection (е) with hyperintensive signal in arched joints LIV–LV, LV–LVI III degree according to A. Fujiwara [14]

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