Understanding quality of life and treatment history of patients with Bertolotti syndrome compared with lumbosacral radiculopathy

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OBJECTIVE

Bertolotti syndrome is a rare spinal condition that causes low-back pain due to a lumbosacral transitional vertebra (LSTV), which is a pseudoarticulation between the fifth lumbar transverse process and the sacral ala. Bertolotti syndrome patients are rarely studied, particularly with regard to their quality of life. This study aimed to examine the quality of life and prior treatments in patients with Bertolotti syndrome at first presentation to the authors’ center in comparison with those with lumbosacral radiculopathy.

METHODS

This study was a retrospective cohort analysis of patients with Bertolotti syndrome and lumbosacral radiculopathy due to disc herniation seen at the authors’ institution’s spine center from 2005 through 2018. Diagnoses were confirmed with provider notes and imaging. Variables collected included demographics, diagnostic history, prior treatment, patient-reported quality of life metrics, and whether or not they underwent surgery at the authors’ institution. Propensity score matching by age and sex was used to match lumbosacral radiculopathy patients to Bertolotti syndrome patients. Group comparisons were made using t-tests, Fisher’s exact test, Mann-Whitney U-tests, Cox proportional hazards models, and linear regression models where variables found to be different at the univariate level were included as covariates.

RESULTS

The final cohort included 22 patients with Bertolotti syndrome who had patient-reported outcomes data available and 46 propensity score–matched patients who had confirmed radiculopathy due to disc herniation. The authors found that Bertolotti syndrome patients had significantly more prior epidural steroid injections (ESIs) and a longer time from symptom onset to their first visit. Univariate analysis showed that Bertolotti syndrome patients had significantly worse Patient-Reported Outcomes Measurement Information System (PROMIS) mental health T-scores. Adjustment for prior ESIs and time from symptom onset revealed that Bertolotti syndrome patients also had significantly worse PROMIS physical health T-scores. Time to surgery and other quality of life metrics did not differ between groups.

CONCLUSIONS

Patients with Bertolotti syndrome undergo significantly longer workup and more ESIs and have worse physical and mental health scores than age- and sex-matched patients with lumbosacral radiculopathy. However, both groups of patients had mild depression and clinically meaningful reduction in their quality of life according to all instruments. This study shows that Bertolotti syndrome patients have a condition that affects them potentially more significantly than those with lumbosacral radiculopathy, and increased attention should be paid to these patients to improve their workup, diagnosis, and treatment.

ABBREVIATIONS ESI = epidural steroid injection; LSTV = lumbosacral transitional vertebra; ODI = Oswestry Disability Index; PDQ = Pain Disability Questionnaire; PHQ-9 = Patient Health Questionnaire 9; PRO = patient-reported outcome; PROMIS = Patient-Reported Outcomes Measurement Information System; QOL = quality of life.

Article Information

Correspondence Joshua L. Golubovsky: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH. goluboj@ccf.org.

INCLUDE WHEN CITING Published online April 19, 2019; DOI: 10.3171/2019.2.SPINE1953.

Disclosures Dr. Steinmetz: consultant for Globus, Stryker, and Intellirod; support of non–study-related clinical or research effort from Globus; and royalties from Zimmer.

© AANS, except where prohibited by US copyright law.

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    CT scans obtained in 2 patients with Bertolotti syndrome who later underwent resection. Left: Image obtained in a patient with a left-sided LSTV formed between an aberrant L5 transverse process, the sacral ala, and part of the ilium. Right: Image obtained in a patient with a right-sided LSTV formed between an aberrant L5 transverse process and the sacral ala only. Different configurations of LSTV exist, with bilateral LSTV also being possible. Figure is available in color online only.

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