Decompressive L5 Transverse Processectomy for Bertolotti’s Syndrome: A Preliminary Study

Background: Bertolotti’s syndrome is a spinal disorder characterized by abnormal enlargement ofthe transverse process of the most caudal lumbar vertebra. The L5 transverse process may be enlargedeither unilaterally or bilaterally and may articulate or fuse with the sacrum or ilium. Pseudoarticulationbetween the transverse process of the L5 and the alar of the sacrum can cause buttock pain and legpain. In addition, the L4 exiting nerve root could be compressed by an enlarged L5 transverse process.The authors could have obtained satisfactory results from the selected cases of Bertolotti’s syndromeby applying a selective transverse processectomy of the L5.Objective: The objective of this study is to determine the effectiveness of L5 transverse processectomyfor symptomatic Bertolotti’s syndrome.Study Design: A retrospective study.Methods: A total of 256 patients with Bertolotti’s syndrome who had severe buttock pain andunilateral or bilateral radiating leg pain were selected. The correct diagnosis was made based onimaging studies which included computed tomography (CT), plain x-rays, and magnetic resonanceimaging (MRI). The final diagnosis was made by confirming pain relief from anesthetic block. A totalof 87 patients were classified into 2 groups: group A included 50 patients whose pain was relieved byblock into the pseudoarticulation and group B included 37 patients whose pain was relieved by blockinto the L4 exiting nerve root. A total of 61 cases (group A: 39 cases, group B: 22 cases) were selectedas pure L5 transverse processectomy.Outcome Measures: The primary outcome measures were reduction in pain scores and improvementin quality of life.Results: Among 61 patients, there were 19 men and 42 women. The mean age of the patients was53.2 ± 12 years (group A: 57.8 ± 14 years [16 – 86 years], group B: 53.4 ± 14 years [27 – 77 years]).The mean follow-up period was 6.5 months. The patients’ mean visual analog scale (VAS) prior tosurgery was 7.54 ± 0.81 (group A: 7.59 ± 0.93, group B: 7.50 ± 0.86), and the mean postoperativeVAS was 2.86 ± 1.67 (group A: 3.82 ± 1.59, group B: 2.05 ± 1.00). According to Macnab’s criteria,12 patients showed excellent results (group A: 3, group B: 9), 41 patients showed good results (groupA: 11, group B: 30), 6 patients showed fair results (group A: 5, group B: 1), and 2 patients showedpoor results (group A: 2, group B: 0). Thus, satisfactory results were achieved in 86.89% of the cases.Conclusion: In patients with Bertolotti’s syndrome, pseudoarticulation as well as L4 nerve rootcompression can be the source of buttock pain and lower extremity pain. Bisectional cutting of theL5 transverse process and decompression of the L4 nerve root could be an optimal treatment forBertolotti’s syndrome, and it may be easily approached by the paraspinal approach