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Background Context: Bertolotti syndrome is a clinical diagnosis given to patients with back pain arising from a lumbosacral transitional vertebra (LSTV). A particular class of LSTV involves a pseudoarticulation between the fifth lumbar transverse process and the sacral ala, and surgical resection of the pseudoarticulation may be offered to patients failing conservative management. Bertolotti syndrome is still not well understood, particularly regarding how patients respond to surgical resection of the LSTV pseudoarticulation.Purpose: To examine change in quality-of-life (QOL) and patient satisfaction following surgical resection of the LSTV pseudoarticulation in patients with Bertolotti syndrome.Design: Ambidirectional observational cohort study of patients seen at a single institution's tertiary spine center over a 10-year period.Patient Sample: Cohort consisted of 31 patients with Bertolotti Syndrome who underwent surgical resection of the pseudoarticulation.Outcome Measures: Preoperative and postoperative Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) Mental and Physical Health T-scores, and a single-item postoperative satisfaction questionnaire.Methods: Patients were identified through diagnostic and procedural codes. Immediate preoperative PROMIS-GH scores available in the chart were gathered retrospectively, and postoperative PROMIS-GH and satisfaction scores were gathered prospectively through a mail-in survey.Results: Mean (SD) improvement of PROMIS-GH Physical Health T-score was 8.7 (10.5) (p<.001). Mean (SD) improvement of PROMIS-GH Mental Health T-scores was 5.9 (9.2) (p=.001). When stratifying PROMIS-GH T-scores by response to the patient satisfaction survey, there were significant group differences in mean change for Physical Health T-scores (p<.001), and Mental Health T-score (p=.009). Patients who stated, "The treatment met my expectations" had much greater mean improvement in the PROMIS-GH T-scores.Conclusions: Patients undergoing a pseudoarticulation resection procedure may experience a significant improvement in quality-of-life as measured by PROMIS-GH Mental and Physical Health. [ABSTRACT FROM AUTHOR]

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Bertolotti Syndrome is a diagnosis given to patients experiencing pain caused by the presence of a lumbosacral transitional vertebra (LSTV), which is characterized by enlargement of the L5 transverse process(es), with potential pseudoarticulation or fusion with the sacrum. The Castellvi classification system is commonly utilized to grade LSTVs based on the degree of contact between the L5 transverse process(es) and the sacrum. LSTVs present a diagnostic dilemma to the treating clinician, as they may remain unidentified on plain x-rays and even advanced imaging; additionally, even if the malformation is identified, patients with a LSTV may be asymptomatic or have nonspecific symptoms, such as low back pain with or without radicular symptoms. With low back pain being extremely prevalent in the general population; it can be difficult to implicate the LSTV as the source of this pain. Care should be taken however, to exclude Bertolotti Syndrome in patients under 30 years old presenting with persisting low back pain given its congenital origin. If a LSTV is identified, typically with acquisition of a MRI or CT scan of the lumbosacral spine, and there is an absence of a more compelling or obvious source for the patient's symptoms, a conservative, step-wise management plan is recommended. This may include assessing for improvement in symptoms with injections prior to proceeding with surgical intervention. Additional concerns arise from the biomechanical alterations that a LSTV induces in adjacent spinal levels, predisposing this patient population to a more rapid-onset of adjacent segment disease, raising the question as to the most appropriate surgery (resection of LSTV pseudoarticulation with or without fusion). Postoperative outcome data for patients undergoing surgical treatment is limited in the literature with promising, but variable, results. More large-scale, controlled studies must be performed to gain further insight into the ideal work-up and management of this pathology. [ABSTRACT FROM AUTHOR]

Background: Atlantoaxial pseudoarticulation rarely involves the cervical spine, and its etiology is unclear. In theory, pseudoarticulation is comparable to Bertolotti's syndrome in the lumbar spine or may be attributed to an aberrant focal fusion between C0-C1-C2 that occurs during the gastrulation of embryologic development. Case Description: A 39-year-old female presented with neck pain and upper extremity weakness. Magnetic resonance/computed tomography studies documented a left-sided unilateral pseudoarticulation between the lamina of C1 and C2 causing compression of the dorsal spinal cord. Following resection of the accessory C1/C2 joint utilizing a C1 hemilaminectomy and partial C2 laminectomy, the patient's neck pain and weakness resolved. Histologically, the tissue showed benign osteocartilaginous tissue with no synovial capsule. Conclusion: Here, the authors present a case of occiput-C1-C2 pseudojoint formation, leading to clinical and radiographic findings of cord compression due to boney outgrowth. [ABSTRACT FROM AUTHOR]