(Kiosk 5) Treatment of Bertolotti’s Syndrome Improved Functional Measures in AIS D SCI Patient: A Case Report

Case Diagnosis: 53-year-old male with T9 AIS D Spinal Cord Injury (SCI) secondary to thoracic myelopathy status post laminectomies in 10/2020 found to have Bertolotti’s Syndrome and treated successfully to improve functional measures.

Case Description or Program Description: Patient presented to outpatient Pain Medicine Clinic with insidious onset low back pain for 12-18 months following laminectomies for thoracic myelopathy. Pain 6/10, non-radiating, and interferes with ambulation, balance, and Activities of Daily Living (ADL’s) (vacuuming, long car rides, sleep). Following surgery he now ambulates with assistance of single point cane with left hip hike due to SCI and intermittent muscle spasms. Exam notable for right hip flexor and knee extensor/flexor weakness, patellar and Achilles hyperreflexia, positive stork test, clonus, axial loading, and trunk rotation testing. Imaging revealed 6 non-rib vertebrae with lumbosacral transitional anatomy (L6) and prominent transverse process that articulate with sacrum consistent with Bertolotti’s Syndrome. Patient underwent bilateral L6-S1 pseudo facet diagnostic and therapeutic joint injections using fluoroscopic guidance.

Setting: Tertiary VA Pain Medicine Clinic

Assessment/Results: At 6 weeks post injection the patient’s low back pain had completely resolved, right lower extremity weakness had improved in hip flexion, knee flexion and extension. His ambulation and ADL’s (vacuuming, dishes, car rides) had also improved.

Discussion (relevance): Approximately 1% or 340,000 people in US have an SCI. Prevalence of lumbosacral transitional anatomy is 8.3%-30% in general population with incidence of bilateral transverse pseudofacet joints consistent with Bertolotti’s Syndrome in approximately 18.3% of those patients. The rare combination of Bertolotti’s Syndrome in an SCI patient contribute to the difficulty of diagnosis and treatment.

Conclusions: Chronic low back pain in spinal cord injury can be difficult to discern from pseudo facet joint pain in Bertolotti’s Syndrome. Proper interpretation of imaging combined with detailed physical exam can lead to accurate diagnosis that was successfully treated with improvement of functional abilities in SCI population.