TABLE 1.
Literature review of studies reporting outcomes of different operative management techniques for the treatment of low back pain in Bertolotti’s syndrome
| Authors & Year | No. of Patients | Mean Age in Yrs (range) | No. of Females/Total | Operative Management (no. of cases) | Pain Outcomes (no. of cases) | Conclusion |
|---|---|---|---|---|---|---|
| Jonsson et al., 198914 |
11 |
39 (13–76) |
6/11 |
LSTV open resection |
Complete resolution (7), significant improvement (2), unchanged from preop levels (2) |
LSTV resection in patients w/ temporary pain relief of lower back pain after anesthetizing joint articulation is worthwhile procedure |
| Santavirta et al., 199316 |
16 |
34 (27–58) |
11/16 |
Posterolat fusion (8), LSTV open resection (8) |
Improvement (10), patients required 2nd operation (6; 3/6 fusions) |
Surgical treatment w/ resection or fusion in Bertolotti’s syndrome should be attempted in select cases that failed conservative management |
| Abe et al., 199717 |
1 |
37 |
0/1 |
Ant decompression w/ resection of bone spur using wide muscle-splitting extraperitoneal approach |
Good relief of low back pain & radiculopathy obtained |
Selective radiculography provided optimal diagnostic value as method of exam for far-out foraminal stenosis; ant approach to decompression of far-out foraminal stenosis below LSTV is simple & effective treatment |
| Brault et al., 200115 |
1 |
17 |
1/1 |
Resection of anomalous lumbosacral articulation |
Symptom free at last FU |
Low back pain may occur from facet contralat to unilat LSTV, even in young patients; resection of anomalous articulation can provide excellent results due to unloading of force on symptomatic facet |
| Ichihara et al., 200420 |
1 |
34 |
1/1 |
Pst decompression by LSTV open resection |
Complete resolution |
Pst decompression is easy, safe, & useful method of treatment for radicular pain caused by a Bertolotti joint when conservative management failed |
| Ugokwe et al., 200823 |
1 |
40 |
0/1 |
Minimally invasive resection of anomalous, enlarged transverse process at caudal-most lumbar vertebra involved in pseudoarticulation at sacral ala |
97% resolution of pain at 6-mo FU |
Minimally invasive approaches can be as effective as conventional approaches to treat LSTV while minimizing trauma associated w/ surgical exposure |
| Miyoshi et al., 201124 |
1 |
29 |
0/1 |
Pst decompression by osteophyte resection |
Complete resolution |
Pst decompression is effective form of management for radicular pain caused by foraminal stenosis secondary to LSTV |
| Weber and Ernestus, 201121 |
1 |
53 |
1/1 |
Lat foraminal & extraforaminal nerve root decompression |
No low back or radicular pain & no radiographic signs of instability at 12 mos |
Extraforminal impingement originating from below transitional vertebra in Castellvi type IIA and IIB can be relieved by lat foraminal & extraforaminal radicular decompression |
| Shibayama et al., 201122 |
1 |
46 |
1/1 |
Extraforaminal decompression of rt L6 nerve root involving removal of lower part of enlarged transverse process & upper part of sacral ala |
At 30-mo FU, VAS score had decreased 10 points; JOA score increased from 10 to 25 |
Clinical presentation of intractable sciatica-like pain could arise from impingement of nerve root extraforaminally by compression caused by transverse process |
| Kikuchi et al., 201318 |
2 |
61.5 (53–70) |
1/2 |
Ant decompression by osteophyte resection |
Complete resolution (2) |
L5 extraforaminal stenosis below LSTV causes nerve entrapment more ant to L5 nerve than in other pathologies, so ant decompression results in more complete decompression |
| Malham et al., 201319 |
2 |
38 (27–49) |
1/2 |
Ant retroperitoneal LSTV resection |
Significant improvement (2) |
Ant approach for pseudoarthrectomy in treatment of Bertolotti’s syndrome is safe & effective approach for long-term symptomatic relief |
| Takata et al., 201425 |
1 |
45 |
1/1 |
Minimally invasive microendoscopic LSTV resection & discectomy |
Complete resolution |
Minimally invasive LSTV resection is effective for treatment of low back pain associated w/ Bertolotti’s syndrome |
| Li et al., 20147 |
7 |
43.3 (26–63) |
4/7 |
Minimally invasive tubular LSTV resection |
Complete resolution (3), improvement (2), initial improvement followed by recurrence (2) |
Minimally invasive surgical approach for LSTV resection is effective for pain resolution in patients w/ Bertolotti’s syndrome w/ pain refractive to conventional therapy |
| Babu et al., 201729 |
2 |
27.5 (17–38) |
2/2 |
LSTV O-arm neuronavigational resection |
Complete resolution (2) |
Excellent outcomes achieved w/ navigation guidance approach to locate & completely resect LSTVs in 2 patients |
| Ju et al., 201726 |
61 |
53 ± 12 |
42/61 |
Combined resection of L5 transverse process & decompression of L4 nerve root |
Average 4.68-point decrease in VAS score across all patients (7.54 preop, 2.86 postop) |
When pain relieved by anesthetic block of pseudoarticulation or selective L4 exiting nerve root, bisectional cutting of base of transverse process of L5 using paraspinal route can be effective treatment for Bertolotti’s |
| Adams et al., 201831 |
1 |
37 |
1/1 |
Nonsegmental pedicle screw instrumentation w/ low-profile screws on rt side w/ fusion using allograft & rh-BMP2 bone graft substitute |
Complete resolution of preop symptoms from rare Castellvi type IV LSTV at 2-wk FU |
Patients w/ symptoms consistent w/ Bertolotti’s syndrome should be considered for surgical treatment even if they have Castellvi type III or IV LSTV |
| Louie et al., 201930 |
2 |
15 (14–16) |
2/2 |
Resection of L5 transverse process |
Pain & functional status improved w/in 6 wks & continued through last FU |
Resection of l5 transverse process fused to sacral ala can reduce pain & improve overall function; even in young patients, surgical intervention should be considered to mitigate yrs of chronic pain & additional degenerative change |
| Mikula et al., 20226 |
27 |
40 ± 16 |
18/27 |
Fusion (9) vs resection (18) |
No statistically significant difference in short-term pain improvement (< 6 mos) btwn fusion & resection groups, but fusion provided superior long-term (> 12 mos) pain improvement |
Patients w/ Bertolotti syndrome who underwent fusion across LSTV had higher rate of long-term pain improvement vs patients who underwent resection of LSTV pseudoarticulation |
| Chang et al., 202232 |
1 |
39 |
0/1 |
Minimally invasive microscopic tubular articular resection w/ C-arm guidance |
Free of pain/symptoms at 2-yr postoperative FU |
Simple resection of pseudoarticulation is most effective surgical treatment in patient w/ degeneration of anomalous articulation or facet joint above LSTV; decompression of nerve root effective for patients w/ radiculopathy who respond to selective nerve root-block procedure; fusion may be indicated when there is coexisting joint instability w/ increased motion |
| Stein et al., 202333 | 1 | 57 | 1/1 | Minimally invasive endoscopic LSTV resection | Sustained improvement | Endoscopic resection of anomalous LSTV is effective treatment for refractory Bertolotti’s syndrome, w/ extensive resection along entire length of LSTV providing more complete pain relief |
ant = anterior; FU = follow-up; pst = posterior; VAS = visual analog scale; JOA = Japanese Orthopedic Association.