Research ArticleArticles

A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome

Jeffrey M. Jancuska, Jeffrey M. Spivak and John A. Bendo
International Journal of Spine Surgery January 2015, 9 42; DOI: https://doi.org/10.14444/2042

Article Figures & Data

Figures

  • Fig. 1
    Fig. 1

    Castellvi radiographic classification system.6

  • Fig. 2
    Fig. 2

    Appearances of LSTV based on Castellvi et al. (a) Type 1b with bilaterally enlarged L5 transverse process but no articulation with the sacrum. (b) Type 2a with unilateral pseudarthrosis. (c) Type 2b with bilateral pseudarthroses. (d) Type 3a with unilateral fusion of the enlarged transverse process to the sacral ala. (e) Type 3b with bilateral fusion. (f) Type 4 appearance with fusion on the left side and a pseudarthrosis on the right.1

  • Fig. 3
    Fig. 3

    Lateral radiograph of the lumbosacral junction showing the typical appearance of an LSTV with “squaring” of the transitional vertebral body and reduced height of the transitional disc.1

  • Fig. 4
    Fig. 4

    A case of L6 vertebra with type IIa transition. Left, T2-weighted sagittal cervicothoracic and (right) lumbar images in the cross-referencing mode of the picture archiving and communication system. This simultaneously demonstrates the marker at the T12–L1 disc space. Counting the vertebral levels caudally from C2 reveals this patient to have 25 presacral vertebrae or 6 lumbar vertebrae.5

  • Fig. 5
    Fig. 5

    Female patient age 62 with low back pain and with degenerative type IIA LSTV articulation (arrows) on the right side on plain film. (B) Non-focal, moderately increased uptake (large arrow) on the upper sacroiliac joint area at the planar scan. Note also the non-focal, minimal, tracer activity (small arrow) corresponding to the right enlarged transverse process. (C) Coronal SPECT image demonstrates focal, markedly increased activity (arrow) located in the degenerative anomalous articulation area. This patient was diagnosed as having active degenerative disease.63

  • Fig. 6
    Fig. 6

    Proposed diagnostic-therapeutic algorithm for evaluation and treatment of Bertolotti's Syndrome.65

Tables

  • Table 1

    Redefining lumbosacral transitional vertebrae (LSTV) classification through integrating the full spectrum of morphological alterations in a biomechanical continuum.2

    Dysplastic L5 Transverse Process (TP)*Type I AType I BType I A F (i/c) or Type I B F(i/c)Type I A F2 or Type I B F2-
    Unilateral TP ≤ 19 mm in width*Bilateral TPs ≤ 19 mm in width* With presence of ipsi/contra lateral rudimentary facet to the side of the L5 enlargement With presence of bilateral rudimentary facets
    Accessory articulationsType II A Type II B Type II A F(i/c) or Type I B F(i/c) Type II A 2F or Type II B 2F
    Unilateral L5-S1 accessory articulation Bilateral L5-S1 accessory articulations With presence of ipsi/contra lateral rudimentary facet to the side of the diarthrosis With presence of bilateral rudimentary facets -
    Sacralisation**Type II AType III BType III CType III A F (i/c) or Type III B F(i/c) or Type IIIC FType III A 2F or Type III B 2F or Type III C 2F
    Unilateral L5-S1 sacralisation Unilateral complete sacralisation with contralateral L5-S1 pseudoarthrosis Bilateral complete L5-S1 sacralisation With presence of ipsi/contra lateral rudiemntary facet to the side of the sacralisation With presence of bilateral rudimentary facets
    Lumbarisation** Type IV A Type IV B Type IV C Type IV D Type IV A F(i/c) or Type IV B F(i/c) or Type IV C F or Type IV D F Type IV A 2F or Type IV B 2F or Type IV C 2F or Type IV D 2F
    Incomplete/partial lumbarisation of S1 as an accessory S1-2 articulation Unilateral complete separation of S1 from sacral mass Bilateral S1-2 accessory articulation Complete sacralisation with residual four segment sacrum With presence of ipsi/contra lateral rudimentary facet to the side of the diarthrosis With presence of bilateral rudimentary facets

    • ↵* Southworth and Bersack.29 Modifications on the Castellvi's classifications are given in bold and italics.

    • ↵** Situations with aymmetric augmentation of the auricular surface may be represented by adding the alphebets SR+ or SL+ for the corresponding right or the left sides.

Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome
Jeffrey M. Jancuska, Jeffrey M. Spivak, John A. Bendo
International Journal of Spine Surgery Jan 2015, 9 42; DOI: 10.14444/2042
Twitter logo Facebook logo Mendeley logo

Jump to section

Keywords