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Abstract
Introduction: Bertolotti's syndrome (BS) is defined as the presence of low back pain (LBP), radiculopathy or both with a dysplastic transverse process (TP) of the fifth lumbar vertebra that is articulated or fused with the sacral base or iliac crest. This study aimed to investigate the prevalence and severity of BS to promote awareness of this disease. Methods: A retrospective review of anteroposterior lumbosacral plain radiographs was conducted between 1 January and 31 December 2017. Patients were recruited via systematic randomised sampling and were then interviewed and examined. The severity of BS was measured objectively using the numerical pain rating scale (NPRS) and Oswestry disability questionnaire (ODQ). Data were analysed using IBM SPSS for Windows version 22. Results: The prevalence of BS was 9.6% (16/166). Age significantly affected the severity of BS. The older and younger groups had a mean ODQ score of 42.86% and 24.08%, respectively (P=0.006). There was no significant relationship found between the prevalence of BS and age (P=0.126). Only one patient was diagnosed with BS during medical consultation. The mean NPRS score was 5.5. The majority of the BS cases were of moderate severity (43.8%), followed by those of minimal severity (31.2%) and severe disability (25%). Conclusion: Early diagnosis of BS and orthopaedic referral are crucial to halt its progression. BS should be considered in patients presenting with LBP during assessments of lumbosacral radiographs.
Keywords: Bertolotti's syndrome, Low back pain, Lumbosacral transitional vertebrae, Underdiagnosis
Introduction
Bertolotti's syndrome (BS) is named after Mario Bertolotti who described this condition in 1917. Lumbosacral transitional vertebrae (LSTV) are a congenitally morphological spinal variation that spans a spectrum from a dysplastic transverse process (TP) of the fifth (L5) lumbar vertebra to partial/complete fusion between the TP of L5 and sacral base or iliac crest.1-5 LSTV associated with low back pain (LBP), radiculopathy or both is defined as BS.
The exact cause of LBP in patients with BS remains uncertain, although a few theories mainly attributed to arthritic changes and disc degeneration have been postulated.1 Specifically, reference has been made to the fact that the disc above the transitional vertebra appears to be at risk of increased degenerative changes, while the disc below appears to be protected.3,6 These findings are also supported by Aihara et...