[Background] Bertolotti’s syndrome is characterized by forming like a pseudoarticulation between the fifth lumbar vertebrae transverse process and sacrum, and produces low back pain. In this study, we examined whether Interventional pain managements (IPM) are able to improve Bertolotti’s syndrome like pain or not.
[Methods] This research was permitted by ethical committee of Tokyo Medical University. We performed a retrospective study about 489 patients who visited our pain clinic that had a pain similar to Bertolotti’s syndrome during the period from April 2012 to September 2016. We have performed a physical and neurologic examination and examined lumbar spine X-rays. Finally, we have picked up patients who had the narrow space between the fifth lumbar vertebrae transverse process and sacrum of X-rays images, and a tenderness induced in the same area. Next, we have examined the reproduced or radiating pains by injecting the contrast agent and local anesthetics into the pseudoarticulation between the fifth lumbar vertebrae transverse process and sacrum. We have defined that patients showed the disappearance of reproduced pain by IPM are Bertolotti’s syndrome like pain positive. And we have evaluated the change of pain dynamics before and after IPM by Numerical Rating Scale (NRS), respectively. Finally, we have performed the statistical analysis by paired-t test and considered p<0.05 is significant.
[Result] 68 of 489 patients showed Bertolotti’s syndrome like pain at the first medical examination and 25 of 68 patients who showed the localized tenderness are performed the blocks by local anesthetics under fluoroscopy. 13 of 25 patients showed the reproduced or radiating pain caused by needle insertion and contrast injection. From our research, rate of the patients with Bertolotti’s syndrome like pain were 2.7% of whole nonspecific low back pain patients. IPM (radiofrequency thermocoagulation) showed the significant reduction of the pain (NRS before IPM was 8.3±0.4, and after IPM was 3.4±0) (p< 0.0001). Most of these patients showed the continuation of the good pain reduction after first IPM and they sometimes had second IPM at the interval between 6 month and one year.
[Conclusion] Regarding the nonspecific low back pain patients, we need to suspect Bertolotti’s syndrome like pain. Appropriated diagnosis based on the multimodal approaches such as various medical examination and careful inspection and IPM lead to good pain management

05 / Interventional pain managements for Bertolotti’s syndrome like low back pain patients : A retrospective study