Percutaneous Full Endoscopic Transverse Processectomy for Bertolotti’s Syndrome

Abstract

The Lumbosacral transitional vertebra (LSTV) is a congenital anomaly and has two types of abnormal vertebrae. Low back pain and leg pain originated from a lumbosacral transitional vertebra (LSTV) known as Bertolotti’s syndrome (BS). We describe our institution’s experience of a L5 transverse processectomy done via a percutaneous endoscopic approach for a patient with Bertolotti’s syndrome. A 64-year-old female patient with persistent left leg radiating pain visited at the spine center. This patients underwent endoscopic L5-S1 foraminoplasty under the diagnosis of foraminal stenosis. However, despite the complete neural decompression, the patient complained of persistent left leg pain. We found that the left transverse process (TP) of L5 vertebra seemed to contact with the ala of sacrum suggesting the Bertolotti’s syndrome (BS). A pseudo-articulation lidocaine injection was given and it was effective in reducing the leg pain. Under local anesthesia, a uniportal endoscopy was introduced to the base of the L5 TP and simply cut in cranial to caudal direction using a high-speed drill in order to block the way of mechanical stress from spine. The patient’s symptoms got relieved after L5 transverse processectomy and she was discharged in a few days.

Keywords

• lumbosacral transitional vertebra (lstv)
• percutaneous full endoscopic surgery
• transverse process