P40。内镜下横突切除术治疗bertolotti综合征

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100664

Ashton Huppert Steed BS , Kenneth Nwosu MD

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引用次数: 0

摘要

背景：bertolotti综合征（BS）是腰骶过渡椎（LSTV）假关节引起的慢性背痛的一种独特且经常被忽视的原因。虽然横突切除术可以减轻机械应力和疼痛，但使用内窥镜技术治疗的报道仍然很少。目的/研究设计/病例报告患者SAMPLEA， 69岁女性，表现为左侧腰痛，活动加重，严重影响其生活质量（QOL）和日常生活活动（adl）。术前Oswestry残疾指数（ODI）为60%，提示严重残疾，视觉模拟评分（VAS）疼痛评分平均为6/10。腰椎CT显示左侧L5横突- s1骶翼假关节。诊断阻断导致100%的症状缓解。在广泛的保守治疗失败后，患者选择接受内镜下左L5-S1横突切除术。结果测量：vas评分、ODI、EQ-5D-5L和手术结果，包括并发症。方法手术技术：采用影像学导航，单门静脉内镜入路进入左侧L5-S1假关节。用高速毛刺和Kerrison钳切除左L5横突的尾侧半部分。术中通过手触诊和术中减压后CT成像确认减压是否充分，确保假关节完全切除。结果患者术后无并发症，症状完全缓解。6周时，她的VAS疼痛评分为0，并持续了6个月的随访。6个月时，患者ODI为0，EQ-5D-5L评分为1，反映功能和生活质量完全恢复。结论：对于对非手术治疗无反应的BS患者，内镜下横突切除术是一种安全、超微创的手术选择。需要进一步的研究来验证其在更大患者群体中的有效性。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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P40. Endoscopic transverse processectomy for treatment of bertolotti syndrome

BACKGROUND CONTEXT

Bertolotti Syndrome (BS) is a unique, and often missed, cause of chronic back pain due to pseudoarticulation in lumbosacral transitional vertebrae (LSTV). While transverse processectomy can alleviate mechanical stress and pain, reports of its treatment using endoscopic techniques remain rare.

PURPOSE

N/A

STUDY DESIGN/SETTING

Case Report

PATIENT SAMPLE

A 69-year-old female presented with left-sided low back pain exacerbated by activity, significantly impairing her quality of life (QOL) and activities of daily living (ADLs). Preoperative Oswestry Disability Index (ODI) was 60%, indicating severe disability, and her visual analog scale (VAS) pain score averaged 6/10. Lumbar CT revealed a left L5 transverse process-S1 sacral ala pseudoarticulation. A diagnostic block resulted in 100% symptom relief. After failing extensive conservative treatments, the patient elected to undergo endoscopic left L5-S1 transverse processectomy.

OUTCOME MEASURES

VAS score, ODI, EQ-5D-5L, and surgical outcome including complications.

METHODS

Surgical Technique: Using imaging navigation, a uniportal endoscopic approach was employed to access the left L5-S1 pseudoarticulation. The caudal half of the left L5 transverse process was resected with a high-speed burr and Kerrison rongeurs. Adequacy of decompression was confirmed intraoperatively through manual palpation and post-decompression intraoperative CT imaging, ensuring complete removal of the pseudoarticulation.

RESULTS

Postoperatively, the patient experienced no complications and reported complete resolution of symptoms. At six weeks, her VAS pain score was 0, and sustained through six months of follow-up. By six months, her ODI was 0, and her EQ-5D-5L score was 1, reflecting full restoration of function and QOL.

CONCLUSIONS

Endoscopic transverse processectomy demonstrates potential as a safe, ultra-minimally invasive surgical option for BS patients unresponsive to non-surgical treatments. Further research is necessary to validate its efficacy in larger patient cohorts.