Local injection therapy for pain syndrome in patients with lumbosacral transitional vertebrae

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OBJECTIVE

To review the current literature data on local injection therapy for pain syndrome in patients with lumbosacral transitional vertebrae.

MATERIAL AND METHODS

We analyzed the PubMed, CYBERLENINKA, eLIBRARY and Google Scholar databases and selected 71 articles.

RESULTS

Local injection therapy of pain in patients with lumbosacral transitional vertebrae is carried out in the area of pseudoarthrosis formed by the enlarged transverse process of the LV vertebra and sacral wing. Lidocaine is the most common local anesthetic, and glucocorticoids can enhance therapeutic effect. Accuracy of injection is controlled by fluoroscopy, Doppler ultrasound or computed tomography of the lumbosacral spine. Results of blockades are assessed using visual analogue scale (50% decrease of baseline scores or VAS score < 3.0 is a good immediate result). The highest effectiveness of blockades was noted in short-term period (from 2 weeks to 3 months). In some cases, positive effect of local injection therapy is considered as a clinical indication for surgery (pseudoarthrectomy).

CONCLUSION

The problem of pain management in patients with lumbosacral transitional vertebrae is still important. Local injection therapy is an affordable, inexpensive, effective and safe method allowing temporary relief of lower back pain.

Keywords:

lumbosacral transitional vertebrae

pain

local injection therapy

Authors:

Skryabin E.G.

Tyumen State Medical University

ORCID: 0000-0002-4128-6127

Received:

28.11.2022

Accepted:

07.12.2022

List of references:

Parfenov VA, Yakhno NN, Kukushkin ML, Churyukanov MV, Davydov OS, Golovacheva VA, Isaikin AI, Achkasov EE, Evzikov GYu, Karateev AE, Khabirov FA, Shirokov VA. Acute nonspecific (musculoskeletal) low back pain Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, nejropsikhiatriya, psikhosomatika. 2018;10(2):4-11. (In Russ.). https://doi.org/10.14412/2074-2711-2018-2-4-11
Litvinov II, Lokhovinin IV, Savgachev VV. Caudal epidural blocks for chronic low back pain in working age. Medical Council. 2021;21(2):143-151. (In Russ.). https://doi.org/10.21518/2079-701x-2021-21-2-143-151
Bakhtadze MA, Lusnikova IV, Kanaev SP, Rasstrigin SN. Pain in the lower back: which scales and questionnaires to choose? Russian Journal of Pain. 2020;18(1):22-29. (In Russ.). https://doi.org/10.17116/pain20201801122
Gianola S, Bargeri S, Del Castillo G, Corbetta D, Turolla A, Andreano A, Moja L, Castellini G. Effectivenes of treatments for acute and subacute mrchanicaal nonspecific low back pain: A systematic review with network meta-analysis. Br J Sports Med. 2022;56(1):41-50. https://doi.org/10.1136/bjsports-2020-103596
Roy R, Galan S, Sanchez-Rodriguez E, Racine M, Sol E, Jensen MP, Miro J. Cross-National Trends of Chronic Back Pain in Adolescents: Results From the HBSC Study, 2001—2014. J Pain. 2022;23(1):123-130. https://doi.org/10.1016/j.jpain.2021.07.002
Vraa M, Pascoe S, Maddox D, Rhon DI, Cleland JA, Young JL. Prevalence and extent of low back pain and low back-related disability in non-care-seeking working age adults. Muskuloskelet Sci Pract. 2022;60:102572. https://doi.org/10.1016/j.msksp.2022.102572
Walker BF. The prevalence of low back pain: A systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000;13:205-217. https://doi.org/10.1097/00002517-20000000-00003
Luo R, Barsoum D, Ashraf H, Cheng J, Hurwitz NR, Goldsmith CY, Moley PJ. Prevalence of Lumbosacral Transitional Vertebrae in patients With Symptomatic Femoroacetabular Impingement Requiring Hip Arthroscopy. Arthroscopy. 2021;37(1):149-155. https://doi.org/10.1016/j.arthro.2020.08.034
Vaidya R, Bhatia M. Lumbosacral transitional vertebra in military aviation candidates: A cross-section study. Indian J Aerosp Med. 2021;65(1):29-32. https://doi.org/10.25259/JASM_50_2020
Kappor K, Shukla A. Lumbosacral Transitional Vertebra: Prevalence and Association with Low Backache. Med Res Chronicles. 2022;9(1):38-44. https://doi.org/10.26838/MEDRECH.2022.9.2.578
Gungor O, Ozturk C, Ramadan SU, Cesur T. Assessment of X-ray together in the diagnosis of the transitional vertebrae. Bozok Med J. 2022;12(1):1-5. https://doi.org/10.16919/bozoktip.917189
Konin GP, Walz DM. Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance. AJNP. 2010;31(10):1778-1786. https://doi.org/10.3174/ajnr.A2036
Holm EK, Bunger C, Foldager CB. Symptomatic lumbosacral transitional vertebra: A review of the current literature and clinical outcomes following steroid injection or surgical intervention. SICOT J. 2017;3:71. https://doi.org/10.1051/socotj/2017055
Kanematsu R, Hanakita J, Takahashi T, Minami M, Tomita Y, Honda F. Extraforaminal entrapment of the fifth lumbar spinal nerve by neoarthrosis in patients with lumbosacral transitional vertebrae. Eur Spine J. 2020;29(9):2215-2221. https://doi.org/10.1007/s00586-020-06460-1
Skryabin EG. Sacralization LV vertebrae (Bertolotti’s syndrome): literature review. Genji ortopedii. 2022;28(5):726-733. (In Russ.). https://doi.org/10.18019/1028-4427-2022-28-5-726-733
Dhanjani S, Altaleb M, Marqalit A, Puvanesrajah V, Jain A. Pediatric Back Pain Associated with Bertolotti Syndrome: A Report of 3 Cases with Varying Treatment Strategies. JBJS Case Connect. 2021;11(4):2100068. https://doi.org/10.2106/JBJS.CC.21.00068
Marks RS, Thulbourne T. Infiltration of anomalous lumbosacral articulations. Steroid and anesthetic injections in 10 back-pain patients. Acta Orthop. Scand. 1991;62(2):139-141. https://doi.org/10.3109/17453679108999242
Manchikanti L, Cash KA. McManus CD, Pampati V, Benyamin RM. A randomized, double-blind, active-controlled trial of fluoroscopic lumbar interlaminar epidural injections in chronic axial or discogenic low back pain: results of 2-year follow-up. Pain Physician. 2013;16(5):491-504.
Quirachi NA. Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta analysis. Eur Spine J. 2012;21(2):214-2019. https://doi.org/10.1007/s00586-011-2008-y
Ashour A, Hassan A, Aly M, Nafady MA. Prevalence of Bertolotti’s Syndrome in Lumbosacral Surgery Procedures. Cureus. 2022;14(6):26341. https://doi.org/10.7759/cureus.26341
Yulin VS, Shpagin MV, Kolesnikov MV. Bertolott’s syndrome. Trudnyj patsient. 2020;18(3):13-16. (In Russ.). https://doi.org/10.24411/2074-1995-2020-10012
Johnson ZD, Aoun SG, Ban VS, El Ahanadieh TY, Kafka B, Wolfe C, Adogwa O, Bayly CA, Al Tamimi M. Bertolotti syndrome With Articulated L5 Transverse Process Causing Intractable Back Pain: Surgical Video Showcasing a Minimally Invasive Approach for Disconnection: 2-Dimensional Operative Video. Oper Neurosurg. 2021;20(3):219-220. https://doi.org/10.1093/ons/opaa343
Golubovsky JL, Momin A, Thompson NR, Steinmetz MP. Understanding quality of life and treatment history of patients with Bertolotty syndrome compated with lumbosacral radiculopathy. J Neurosurg Spine. 2019;19:1-7. https://doi.org/10.3171/2019.2.SPINE1953
Park MK, Son SK, Park WW, Choi SH, Jung DY, Kim DH. Unilataral Biportal Endoscopy for Decompression of Extraforaminal Stenosis at the Lumbosacral Junction: Surgical Techniques and Clinical Outcomes. Neurospine. 2021;18(4):871-879. https://doi.org/10.14245/ns.2142146.073
Iwasaki M, Akiyma M, Koyanagi I, Niiya Y, Ihara T, Houkin K. Double Cruch of L5 Spinal Nerve Root due to L4/L5 Lateral Recess Stenosis and Bony Spur Formation of Lumbosacral Transitional Vertebra Pseudoarticulation: A Case Report and Review. NMC Case Rep J. 2017;4(4):121-125. https://doi.org/10.2176/nmccrj.cr.2016-0308
Bureta CA, Yamamoto T, Ishidou Y, Abematsu M, Tominaga H, Horinouchi S, Yone K, Komyia S, Taniguchi N. Extraforaminal L5 Nerve Root Compression Caused by Intervertebral Osteophyte Accompanied by Lumbosacral Transitional Vertebra: A Case Treated by Anterior Approach. World Neurosurg. 2019;127:464-468. https://doi.org/10.1016/j.wneu.2019.04.104
Becker L, Schonnagel L, Michalache TV, Haffer H, Schoming F, Schmidt H, Pumberger M. Lumbosacral transitional vertebrae alter the distribution of lumbar mobility — Preliminary results of a radiographic evaluation. PLoS One. 2022;17(9):0274581. https://doi.org/10.1371/journal.pone.0274581
Aihara T, Takahashi K, Ogasawara A, Itadera E, Ono Y, Moriya H. Intervertebral disc degeneration associated with lumbosacral transitional vertebrae. A clinical and anatomical study. J Bone Joint Surg Br. 2005;87(5):687-691. https://doi.org/10.1302/0301-620X.87B5.15727
Yurkovsky AM. Examination of the iliopsoas ligament for low back pain syndrome. Problemy zdorov’ya i ekologii. 2011;29(3):106-110. (In Russ.).
Becker L, Ziegeler K, Diekhoff T, Palmovsky Y, Pumberger M, Schoming F. Muskulature adaption with lumbosacral transitional vertebrae: A matched-pair analysis of 46 patients. Skeletal Radiology. 2021;50:1697-1704. https://doi.org/10.1007/s00256-021-03722-x
Kudryavtseva IP, Safonova GD, Berdyugin KA. The state of paravertebral muscles in diseases of the spine (literature review). Sovremennye problemy nauki i obrazovaniya. 2015;5. (In Russ.). Accessed November 16, 2022. https:/science-education.ru/ry/article/view?id=22104
Ju CI, Kim SW, Kim JG, Lee SM, Shin H, Lee HY. Decompressive L5 Transverse Process ectomy for Bertolotti’s syndrome: A Preliminary Study. Pain Physician. 2017;20(6):923-932.
Ravikant R., Majumdar P. Bertolotty’s syndrome in low-backache population: Classification and imaging finding. Ci Ji Yi Xue Za Zhi. 2019;31(2):90-95. https://doi.org/10.4103/tcmj_209_17
Yang S, Kim W, Kong HH, Do KH, Choi KH. Epidural steroid injection versus conservative treatment for patient with lumbosacral radicular pain: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020;99(30):21283. https://doi.org/10.1097/MD.0000000000021283
Wiliams AL, Leggit JC. Epidural Corticosteroid Injections for Lumbosacral Radicular Pain. Am Fam Physician. 2021;103(7):405-406.
Celenlioglu AE, Sensan S, Bilim S, Sansar M, Gunduz OH. Comparison of Caudal Versus Transforaminal Epidural Steroid Injection in Post Lumbar Surgery Syndrome After Single-level Discectomy: A Prospective Randomizid Trial. Pain Physician. 2022;25(2):161-169.
Kumar J, Ali S, Zadran N, Singh M, Ahmed Z. A Rare Case of Bertolotti’s Syndrome in a Young Patients: A case Report and Literature Review. Cureus. 2020;12(10):10957. https://doi.org/10.7759/cureus.10957
Matson DM, MacCormick LM, Sembrano JN, Polly DW. Sacral Dysmorphism and Lumbosacral Transitional Vertebrae (LSTV). Review. Int J Surg. 2020;14(1):14-19. https://doi.org/10.14444/6075
Takata Y, Sakai T, Higashino K, Goda Y, Mineta K, Sugiura K, Sairyo K. Minimaly Invasive Microendoscopic Resection of the Transverse Process for Treatment of Low Back Pain with Bertolott’s Syndrome. Case Rep Othop. 2014;2014:613971. https://doi.org/10.1155/2014/613971
Glémarec J, Varin S, Cozic C, Tanguy G, Volteau C, Montigny P, Le Goff B, Darrieutort Laffite C, Maugars Y, Cormier G. Efficacy of local glucocorticoid after local anesthetic in low back pain with lumbosacral transitional vertebra: A randomized placebo-controlled double-blind trial. Joint Bone Spine. 2018;85(3):359-363. https://doi.org/10.1016/j.jbspin.2017.05.003
Ali L, Ahmad K, Ali U. A rare case of low backache (Bertolotti′s Syndrome). Anest pain intensive care. 2021;25(2):402-405. https://doi.org/10.35975/apic.v25i3.1508
Jacobs DK. A 15-year-old Female Cross Country Runner with Bertolotti’s Syndrome with an Intra-articular Injection at the Pseudoartriculation Site. PM&R. 2019;11(suppl 2):6-8.
Chang GT, Anuar MSB, Ibrahim KB, Baharudin AB, Ariffin MHBM. A Case Reports of Intra-Articular Steroid Injection in the Treatment of Bertolotti’s Syndrome. AJORR. 2018;1(2):1-6. https://doi.org/10.9734/AJORR/2018/44876
Alonzo F, Cobar A, Cahueque M, Prieto JA. Bertolotti’s syndrome: An under diagnosed cause for lower back pain. J Surg Case Rep. 2018;2018(10):276. https://doi.org/10.1093/jscr/rjy276
Crane J, Cragon R, O’Niel R, Berger AA, Kassem H, Sherman WF, Paladini A, Varrassi G, Odisho AS, Mirigala S, Kaye AD. A Comprehensive Update of the Treatment and Management of Bertolrtti’s Syndrome: A Best Practices Review. Orthop Rev. 2021;13(2):24980. https://doi.org/10.52965.001c.24980
Ghai B, Kumar K, Bansal D, Dhatt SS, Kanukula R, Batra YK. Effectiveness of Parasagittal Interlaminar Epidural Local Anesthetic with or without Steroid in Chronic Lumbosacral Pain: A Randomized, Double-Blind Clinical Trial. Pain Physician. 2015;18(3):237-248.
Tai M, Xiang SCSH, Eow CZ, Ho KLKH, Ong JH, Sirisena D. Ultrasound-guided lumbar spine injection for axial and radicular pain: An early experience from one institution. Asian Spine J. 2021;15(2):216-233. https://doi.org/10.31616/asj.2019.0399
Barkhane Z, Belaaroussi S, Foudail M. Bilateral Bertolotti’s Syndrome: A Case Report of an Uncommon Presentation of Chronic Low Back Pain in an Elder Patient. Cureus. 2022;14(7):26569. https://doi.org/10.7759/cureus.26569
Jain A, Agarwal A, Jain S, Shamshery C. Bertolotti Syndrome: A diagnostic and management dilemma for pain physicians. Korean J Pain. 2013;26(4):368-373. https://doi.org/10.3344/kjp.2013.26.4.368
Jancuska JM, Spivak JM, Bendo JA. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolott’s Syndrome. Int J Spine Surg. 2015;9:42. https://doi.org/10.14444/2042
Griffith JF, Xiao F, Hilkens A, Griffith IHY, Leung JCS. Increased vertebral body area, disc and facet joint degeneration throughout the lumbar spine in patients with lumbosacral transitional vertebrae. Eur Radiol. 2022;32(9):6238-6246. https://doi.org/10.1007/s00330-022-08736-0
Cheng L, Jiang C, Huang J, Jin J, Guan M, Wang Y. Lumbosacral transitional Vertebra Contributed to Lumbar Spine Degeneration: An MR Study of Clinical Patients. J Clin Med. 2022;11(9):2339. https://doi.org/10.3390/jcm11092339
De Almeida DB, Mattei TA, Soria MG, Prandini MN, Leal AG, Milano JB. Transitional lumbosacral vertebrae and low back pain: diagnostic and management of Bertolotti’s syndrome. Arq Neuropsiquatr. 2009;67(2a):268-272. https://doi.org/10.1590/s0009-282x2009000200018
Yoo SW, Ki M-J, Doo AR, Woo CJ, Kim YS, Son J-S. Prediction of successful caudal injection using color Doopler ultrasonography in the paramedian sagittal oblique view of the lumbosacral spine. Korean J Pain. 2021;34(3):339-345. https://doi.org/10.3344/kjp.2021.34.339
Zhang R, Cheng J. Interventional Management of Chronic Low Back Pain Associated with Bertolotti’s Syndrome: Report of Case Series. Ann Clin Case Rep. 2017;2:1348.
Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, Koes BM, Ferreira PH, Cohen SP, Pinto RZ. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):CD013577. https://doi.org/10.1002/14651858.CD013577
Van Zundert J, Hartrick C, Patijn J, Huygen F, Mekhail N, van Kleef M. Evidence-based interventional pain medicine according to clinical diagnoses. Pain Pract. 2011;11(5):423-429. https://doi.org/10.1111/j.1533-2500.2011.00490.x
Skryabin EG. Transitional lumbosacral vertebrae. Kazan Medical Journal. 2022;103(6). (In Russ.). https://org/10.17816/KMJ107495
Tabeeva GR. Muscle relaxants as alternative analgesics in the treatment of nonspecific back pain. Nevrologiya, nejropsikhiatriya, psikhosomatika. 2017;9(2):89-94. (In Russ.). https://doi.org/10.14412/2074-2711-2017-2-89-94
Maslova N, Agafonov K. Oral muscle relaxants for nonspecific back pain. Vrach. 2017;9:38-41. (In Russ.).
Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. https://doi.org/10.7326/M16-2367
Babu H, Lagman C, Kim TT, Grade M, Johnson JP, Drazin D. Intraoperative navigation-guided resection of anomalous transverse processes in patients with Bertolotti’s syndrome. Surg Neurol Int. 2017;8:236. https://doi.org/10.4103/sni.sni_173_17
Ugokwe KT, Chen T-L, Kineberg E, Steinmetz MP. Minimally invasive surgical treatment of Bertolotti’s syndrome: case report. Neurosurgery. 2008;62(5):454-455. https://doi.org/10.1227/01.neu.0000326034.77585.88
Sumarriva G, Cook B, Celestre P. Surgical Resection of Bertolotti Syndrome. Ochsner J. 2022;22(1):76-79. https://doi.org/10.31486/toj.21.0012
Cuenca C, Bataille J, Chouilem M, Ballouhey Q, Fourcade L, Marcheix PC. Bertolotti’s syndrome in children: From low-back pain to surgery. A case report. Neurochirurgie. 2019;65(6):421-424. https://doi.org/10.1016/j.neuchi.2019.06.004
McGrath KA, Thompson NR, Fisher E, Kanasz J, Golubovsky JL, Steinmetz MP. Quality-of-life and postoperative satisfaction following pseudoarthrectomy in patients with Bertolotti syndrome. Spine J. 2022;22(8):1292-1300. https://doi.org/10.1016/j.spinee.2022.02.010
Bellabes S, Doumbeneny MJ, Chavihot C, Nguema BE. Bertolotti’s syndrome: An Underdiagnosed Cause for Lower Back Pain in Young Adults. SAS J Med. 2022;8(4):332-337. https://doi.org/10.36347/sasjm.2022.v08i04.992
Chang C-J, Chiu Y-P, Ji H-R, Chu C-H, Chiu C-D. Surgical interventions for Bertolotti syndrome: A clinical case and a review of unsatisfactory cases in the literature. BMC Surg. 2022;22(1):36. https://doi.org/10.1186/s12893-022-01498-y
Malham GM, Limb RJ, Claydon MH, Brazenor GA. Anterior pseudo arthroectomy for symptomatic Bertolotti’s syndrome. J Clin Neurosci. 2013;20(12):1762-1766. https://doi.org/10.1016/j.jocn.2013.02.018
Wu PH, Sebastian M, Kim HS, Heng GTY. How I do it? Uniportal full endoscopic pseudoarthrosis release of left L5/S1 Bertolotti’s syndrome under intraoperative computer tomographic quidance in an ambulatory setting. Acta Neurochir. 2021;163(10):2789-2795. https://doi.org/10.1007/s00701-021-04975-0
Byvaltsev VA, Kalinin AA, Biryuchkov MYu, Khozeev DV, Dzhubaeva BA, Pestryakov Yu.Ya. Analysis of unsatisfactory results of surgical treatment of patients with anomalies of the lumbosacral junction of the spine. Voprosy nejrokhirurgii im. N.N. Burdenko. 2022;86(1):39-47. (In Russ.). https://doi.org/10.17116/neiro20228601139

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