Bertolotti syndrome treatment [Neurosurgery Wiki]

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====== Bertolotti syndrome treatment ======

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====== Conservative Treatment of Bertolotti Syndrome ======

Conservative treatment is the first-line approach in managing Bertolotti syndrome, aiming to relieve pain and improve function before considering surgical options.

===== 🧠 Overview =====

^ Goals of Conservative Treatment ^
| - Pain relief |
| - Inflammation control |
| - Improved mobility and quality of life |
| - Delay or avoidance of surgery |

===== 🏃‍♂️ 1. Physical Therapy =====
  * Core strengthening to stabilize the lumbar spine
  * Stretching exercises (hamstrings, hip flexors, paraspinal muscles)
  * Postural training
  * Manual therapy (mobilization/manipulation)

===== 💊 2. Pharmacological Management =====
  * NSAIDs (e.g., ibuprofen, naproxen) for inflammation and pain control
  * Muscle relaxants if there is associated spasm
  * Neuropathic agents (e.g., gabapentin) if radicular pain is present

===== 💉 3. Injections =====
  * Corticosteroid + local anesthetic injections into:
    * The pseudoarticulation (if present)
    * Sacroiliac joints
    * Facet joints
  * Useful both for **therapeutic** and **diagnostic** purposes

===== ⚠️ 4. Activity Modification =====
  * Avoidance of aggravating activities (e.g., heavy lifting, prolonged sitting)
  * Ergonomic adaptations at work and home

===== 🔬 5. Imaging-Guided Management =====
  * CT- or fluoroscopy-guided injections for more accurate targeting
  * Consider MRI or CT if symptoms persist to rule out associated pathology

===== 🧠 6. Multidisciplinary Pain Management =====
  * Referral to a pain or spine specialist if symptoms persist
  * Psychological support (e.g., cognitive behavioral therapy) for chronic pain management

====== Bertolotti syndrome surgical treatment ======


===== ⛔ When to Consider Surgery =====
  * Failure of 3–6 months of well-applied conservative treatment
  * Significant functional impairment or persistent radicular symptoms
  * Imaging reveals a clear pain generator (e.g., inflammatory pseudoarthrosis)

----

----
Some studies advocate surgical resection in selected refractory to more conservative approaches
((Jancuska JM, Spivak JM, Bendo JA. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome. Int J Spine Surg. 2015 Jul 29;9:42. doi: 10.14444/2042. PMID: 26484005; PMCID: PMC4603258.))
----
===== 🔪 Surgical Treatment of Bertolotti Syndrome =====

**Goal:** To relieve pain by eliminating the pseudoarticulation and addressing associated lumbar disc disease.

==== 🦴 1. Partial Excision of the Pseudoarthrosis ====
  * **Disconnecting** the enlarged **lumbar transverse process (TP) pseudojoint** from the **sacrum**
  * ✅ **[[Transverse processsectomy]]**:
    * ▪ **MIS-paramedian tubular-microsurgical** partial resection of the anomalous enlarged TP

==== 📉 2. When associated with Lumbar Disc Disease ====

**A. Disc Herniation**
  * ✅ **Lumbar microdiscectomy** combined with **transverse processectomy**

**B. Disc Degeneration**
  * ✅ **Posterolateral fusion** (e.g., **MIS-TLIF or similar**) + **transverse processectomy**



==== Pseudoarthrectomy ====

Complete, Sustained Resolution of Pain With Pseudoarthrectomy for Bertolotti Syndrome: A Case Report
((Husu EN, Parekh N, Simon JI. Complete, Sustained Resolution of Pain With Pseudoarthrectomy for Bertolotti Syndrome: A Case Report. Pain Med Case Rep. 2025 Apr;9(2):103-107. PMID: 40331807.)). 

==== Videos ====

{{youtube>Y0JU2hruzjQ}}