Medical Student Case Western Reserve University School of Medicine Cleveland, Ohio, United States
Introduction: Bertolotti syndrome is a clinical diagnosis given to patients with lower back pain arising from a lumbosacral transitional vertebra (LSTV). The long-term effects of these biomechanical changes on the LSTV adjacent segments are not well understood. This study examined degenerative changes at segments superjacent to the LSTV in patients with Bertolotti Syndrome.
Methods: This study involved a retrospective review of patients with an LSTV and chronic back pain, with and without a documented diagnosis of Bertolotti syndrome between 2010 through 2020. Degenerative changes were assessed by grading the intervertebral disc, facets, degree of spinal stenosis, and spondylolisthesis using well documented grading systems in the literature.
Results: 172 patients were included, 101 with Bertolotti syndrome and 71 controls. Control patients consisted of patients with lower back pain but no diagnosis of Bertolotti syndrome nor an LSTV. The mean age of patients with Bertolotti syndrome was 48.2 years and for control patients, 52.8 (p = 0.091). After adjusting for age and sex, Bertolotti patients had pelvic incidence that was 9.83 degrees greater than control patients (95% CI = 5.15–14.50, P < 0.001). Sacral slope was not significantly different (beta estimate = 3.10, 95% CI = -1.07 – 7.27, P = .144). Bertolotti patients had 2.69 times higher odds of having high disc grade (3–4 vs. 0-2), compared to control patients (OR = 2.69, 95% CI = 1.28–5.90, P = 0.011). There were no significant difference for spondylolisthesis, facet grade, or spinal stenosis grade.
Conclusion : Patients with Bertolotti syndrome have a significantly greater pelvic incidence and degeneration in the suprajacent disc. This association may warrant closer follow-up protocols for patients being treated for Bertolotti syndrome, but further prospective studies are needed to establish if radiographic parameters, such as pelvic incidence and sacral slope, can serve as an indicator for biomechanical alterations in-vivo.
