Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain.
METHODS
Case report of surgically treated mechanical low back pain from the facet joint contralateral to a unilateral anomalous lumbosacral articulation (Bertolotti's syndrome).


OBJECTIVE
To describe the clinical presentation, diagnostic evaluation, and management of facet-related low back pain in a 17-year-old cheerleader and its successful surgical treatment with resection of a contralateral anomalous articulation.


BACKGROUND
Lumbosacral transitional vertebrae are common in the general population. Bertolotti's syndrome is mechanical low back pain associated with these transitional segments. Little is known about the pathophysiology and mechanics of these vertebral segments and their propensity to be pain generators. Treatment of this syndrome is controversial, and surgical intervention has been infrequently reported.


METHODS
A retrospective chart analysis and radiographic review were performed.


RESULTS
Repeated fluoroscopically guided injections implicated a symptomatic L6-S1 facet joint contralateral to an anomalous lumbosacral articulation. Eventually, a successful surgical outcome was achieved with resection of the anomalous articulation.


CONCLUSIONS
Clinicians should consider the possibility that mechanical low back pain may occur from a facet contralateral to a unilateral anomalous lumbosacral articulation, even in a young patient. Although reports of surgical treatment of Bertolotti's syndrome are infrequent, resection of the anomalous articulation provided excellent results in this patient, presumably because of reduced stresses on the symptomatic facet.
Brault
J S
JS
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA.
Smith
J
J
Currier
B L
BL
D000293:Adolescent; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D017060:Patient Satisfaction; D011859:Radiography; D012447:Sacrum / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*