Article recommendation for transitional vertebra

[normalforce]

Hi all.

I am doing a case presentation for an attending and need some recommendation on landmark/excellent articles that discuss. ESIs in patients with lumbar transitional vertebra (beatollotti sp?). If anyone has any good article references I would greatly appreciate it. Thanks.

NF

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[normalforce]

Does anyone have the name of the author/reference who did the SI joint study with CT scans and described the "sweet spot".

Thanks again.

 

[ampaphb]

Hi all.

I am doing a case presentation for an attending and need some recommendation on landmark/excellent articles that discuss. ESIs in patients with lumbar transitional vertebra (beatollotti sp?). If anyone has any good article references I would greatly appreciate it. Thanks.

NF

my immediate first thought is why would you be doing ESI's, rather than facets, as your first intervention in these patients?

Infiltration of anomalous lumbosacral articulations. Steroid and anesthetic injections in 10 back-pain patients.
Acta Orthop Scand. 1991 Apr;62(2):139-41.

In 10 patients with severe, chronic low back pain, we studied the effect of steroid and local anesthetic infiltration of anomalous lumbosacral articulations, formed between a transitional lumbosacral vertebra and the sacrum. There was immediate total relief of pain in 8 patients, and in 1 patient immediate partial relief that became total after approximately 7 days. Five patients subsequently relapsed to their former pain level in periods ranging from 1 day to 12 weeks, 3 patients continued to report adequate partial pain relief after periods of 7 to 41 months, and 1 patient remained free from pain 2 years after infiltration. IN some cases, infiltration of these articulations may be therapeutic, as well as diagnostic.

 

[sciatiquedoc]

Spine. 1989 Dec;14(12):1373-7.Links
Bertolotti's syndrome revisited. Transitional vertebrae of the lumbar spine.

Elster AD.
Department of Radiology, Bowman Gray School of Medicine, Winston-Salem, North Carolina.
Bertolotti's syndrome refers to the association of back pain with lumbosacral transitional vertebrae. Such vertebrae were observed in 140 of 2,000 adults with back pain over a 4-year period of study. Each patient had radiographic evaluation of the lumbar spine by plain films as well as a sectional imaging modality (magnetic resonance [MR] or computed tomography [CT]). The overall incidence of structural pathology (eg, spinal stenosis and disc protrusion) detected by CT or MR was not apparently higher in patients with transitional vertebrae, but the distribution of these lesions was significantly different. Disc bulge or herniation, when it occurred, was nearly nine times more common at the interspace immediately above the transitional vertebra than at any other level. Spinal stenosis and nerve root canal stenosis were more common at or near the interspace above the transitional vertebra than at any other level. Degenerative change at the articulation between the transverse process of the transitional vertebra and the pelvis was an uncommon occurrence; when seen there was no significant correlation with the reported side of pain. It is postulated that hypermobility and altered stresses become concentrated in the spine at the level immediately above a lumbar transitional vertebra. Accelerated disc and facet joint degeneration at this level may then result.
PMID: 2533403 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/2533403