PDF(Pubmed)
Abstract：
Bertolotti\'s syndrome is a syndrome in which the transverse process of the most caudal lumbar vertebra becomes enlarged and articulates with the sacral alar, causing back pain. Here, we report a case of an adolescent basketball player with Bertolotti\'s syndrome who was unable to resume playing despite conservative treatment and underwent an endoscopic partial transverse process and sacral alar resection. A 16-year-old male basketball player presented to our hospital with a chief complaint of left low back pain during exercise and prolonged sitting for over one month. No obvious neurological abnormality was found. X-rays and CT showed lumbosacral transitional vertebrae, and the left transverse process of the sixth lumbar vertebra articulated with the sacrum and iliac, which was the Castellvi classification IIA. A block injection into the articulated surface produced improvement in pain, but the effect was not sustained. Since the patient was refractory to conservative treatments, such as medication and physiotherapy, surgery was performed. During surgery, the articulated transverse process and sacral alar were partially resected endoscopically. Because of the proximity of the resection site to the S1 nerve root, intraoperative electromyography (free-run EMG) was used to detect nerve root irritation symptoms in real time. The patient had no postoperative complications, his low back pain improved immediately, and he returned to play basketball three months after surgery. One year after surgery, the bone resection site showed gradual bone regeneration, and two years after surgery, the transverse process and sacral alar showed a bony bridge. The transverse process was enlarged compared to immediately after surgery but remained smaller than that before surgery. The patient continued to play basketball for two years after surgery without back pain, and no symptoms due to bone regeneration appeared. In the present case, a partial resection of the transverse process and sacral alar was performed with good results. Because the bone resection site was close to the S1 nerve root, the use of an endoscope and intraoperative free-run EMG allowed for a safer procedure during the bone resection. In addition, the patient did not present with symptoms that would affect his basketball performance, although the bone regenerated and bridging occurred between the transverse process and sacral alar over a two-year postoperative course.
摘要：
Bertolotti综合征是一种综合征，其中最尾端腰椎的横突变得扩大，并与骶翼关节，导致背部疼痛。这里,我们报道了一例青少年篮球运动员患Bertolotti综合征的病例，尽管进行了保守治疗，但仍无法恢复比赛，并接受了内镜下部分横突和骶翼切除术。一名16岁的男子篮球运动员来到我们医院，主要主诉是运动期间左下腰痛，长时间坐了一个多月。未发现明显的神经异常。X线和CT显示腰骶移行椎骨，第六腰椎的左横突与骶骨和髂骨铰接，这是卡斯特尔维分类IIA。向关节表面注射块可改善疼痛，但效果没有持续。由于患者对保守治疗难以治疗，比如药物治疗和物理治疗，进行了手术。手术期间,经内镜部分切除关节横突和骶骨。由于切除部位靠近S1神经根，术中肌电图(自由运行肌电图)用于实时检测神经根刺激症状.患者术后无并发症,他的腰痛立即好转，手术三个月后他回来打篮球。手术一年后,骨切除部位表现为逐渐的骨再生，手术两年后，横突和骶骨翼显示骨桥。与手术后立即相比，横突扩大了，但仍比手术前小。病人在手术后继续打篮球两年,没有背痛,并且没有出现由于骨再生的症状。在目前的情况下,对横突和骶骨进行了部分切除，效果良好。因为骨切除部位靠近S1神经根，使用内窥镜和术中自由运行EMG可以在骨切除期间进行更安全的手术.此外,患者没有出现会影响他的篮球表现的症状，尽管在术后两年的时间里，横突和骶骨之间发生了骨再生和桥接。
