Síndrome de Bertolotti como causa de dolor lumbar crónico
Palabras clave:
columna vertebral, anomalías congénitas, lumbago
Resumen
Se presenta el caso de una mujer de 50 años con dolor lumbar crónico de 10 años de evolución, exacerbado en los últimos 5 meses tras sobreesfuerzos. La paciente no tenía antecedentes traumáticos y mostró hallazgos compatibles con síndrome de Bertolotti. Se le realizó un examen físico revelando dolor en región sacroilíaca derecha con maniobra de Patrick positiva. La radiografía mostró seis vertebras lumbares, una de ellas con neoarticulación transversa sacra derecha. El dolor podría estar relacionado con la combinación de la neoarticulación lumbosacra. El tratamiento inicial debe incluir fisioterapia y analgesia. Si los síntomas persisten, se recomienda infiltración sacroilíaca o valoración quirúrgica en casos refractarios. El manejo conservador suele ser efectivo en el síndrome de Bertolotti, pero casos complejos pueden requerir intervención adicional. La vigilancia regular es fundamental para evaluar evolución.
Citas
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2. Li Y, Lubelski D, Abdullah KG, Mroz TE, Steinmetz MP. Minimally invasive tubular resection of the anomalous transverse process in patients with Bertolotti’s syndrome : presented at the 2013 Joint Spine Section Meeting: clinical article. J Neurosurg Spine [Internet]. 2014 [cited 2025 Oct 15];20(3):283–90. Available from: https://pubmed.ncbi.nlm.nih.gov/24358999/ Subscription required
3. McGrath KA, Rabah NM, Steinmetz MP. Identifying treatment patterns in patients with Bertolotti syndrome: an elusive cause of chronic low back pain. Spine J [Internet]. 2021 [cited 2025 Oct 15];21(9):1497–503. Available from: https://pubmed.ncbi.nlm.nih.gov/34010681/ Subscription required
4. McGrath K, Schmidt E, Rabah N, Abubakr M, Steinmetz M. Clinical assessment and management of Bertolotti Syndrome: a review of the literature. Spine J [Internet]. 2021 [cited 2025 Oct 15];21(8):1286–96. Available from: https://pubmed.ncbi.nlm.nih.gov/33676018/ Subscription required
5. Crane J, Cragon R, O’Neill J, Berger AA, Kassem H, Sherman WF, et al. A comprehensive update of the treatment and management of Bertolotti’s syndrome: a best practices review. Orthop Rev (Pavia) [Internet]. 2021 [cited 2025 Oct 15];13(2):24980. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567758/
6. Alonzo F, Cobar A, Cahueque M, Prieto JA. Bertolotti’s syndrome: an underdiagnosed cause for lower back pain. J Surg Case Rep [Internet]. 2018 [cited 2025 Oct 15];2018(10):rjy276. Available from: https://pubmed.ncbi.nlm.nih.gov/30356933/
7. Sahoo RK, Kar R, Patel R, Jadon A. Low back pain from Bertolotti’s syndrome: a not-so-uncommon aetiology. Indian J Anaesth [Internet]. 2020 [cited 2025 Oct 15];64(8):729-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457989/
8. Adams R, Herrera-Nicol S, Jenkins AL. Surgical treatment of a rare presentation of Bertolotti’s syndrome from Castellvi type IV lumbosacral transitional vertebra: case report and review of the literature. J Neurol Surg Rep [Internet]. 2018 [cited 2025 Oct 15];79(3):e70–4. Available from: https://pubmed.ncbi.nlm.nih.gov/30083494/
9. Golubovsky JL, Colbrunn RW, Klatte RS, Nagle TF, Briskin IN, Chakravarthy VB, et al. Development of a novel in vitro cadaveric model for analysis of biomechanics and surgical treatment of Bertolotti syndrome. Spine J [Internet]. 2020 [cited 2025 Oct 15];20(4):638–56. Available from: https://pubmed.ncbi.nlm.nih.gov/31669612/ Subscription required
10. Sumarriva G, Cook B, Celestre P. Surgical resection of Bertolotti syndrome. Ochsner J [Internet]. 2022 [cited 2025 Oct 15];22(1):76–9. Available from: https://pubmed.ncbi.nlm.nih.gov/35355636/
11. Vanelderen P, Szadek K, Cohen SP, De Witte J, Lataster A, Patijn J, et al. Sacroiliac joint pain. Pain Pract [Internet]. 2010 [cited 2025 Oct 15];10(5):470–8. Available from: https://pubmed.ncbi.nlm.nih.gov/20667026/ Subscription required
12. Visser LH, Nijssen PGN, Tijssen CC, van Middendorp JJ, Schieving J. Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis. Eur Spine J [Internet]. 2013 [cited 2025 Oct 15];22(7):1657–64. Available from: https://pubmed.ncbi.nlm.nih.gov/23455949/
13. Kennedy DJ, Engel A, Kreiner DS, Nampiaparampil D, Duszynski B, MacVicar J. Fluoroscopically guided diagnostic and therapeutic intra-articular sacroiliac joint injections: a systematic review. Pain Med [Internet]. 2015 [cited 2025 Oct 15];16(8):1500–18. Available from: https://pubmed.ncbi.nlm.nih.gov/26178855/ Subscription required
14. Szadek K, Cohen SP, de Andrés Ares J, Steegers M, van Zundert J, Kallewaard JW. Sacroiliac joint pain. Pain Pract [Internet]. 2024 [cited 2025 Oct 15];24(4):627–46. Available from: https://pubmed.ncbi.nlm.nih.gov/38155419/
15. Mikula AL, Lakomkin N, Ransom RC, Flanigan PM, Waksdahl LA, Pennington Z, et al. Operative treatment of Bertolotti syndrome: resection versus fusion. World Neurosurg [Internet]. 2022 [cited 2025 Oct 15];165:e311–6. Available from: https://pubmed.ncbi.nlm.nih.gov/35717016 Subscription required
2. Li Y, Lubelski D, Abdullah KG, Mroz TE, Steinmetz MP. Minimally invasive tubular resection of the anomalous transverse process in patients with Bertolotti’s syndrome : presented at the 2013 Joint Spine Section Meeting: clinical article. J Neurosurg Spine [Internet]. 2014 [cited 2025 Oct 15];20(3):283–90. Available from: https://pubmed.ncbi.nlm.nih.gov/24358999/ Subscription required
3. McGrath KA, Rabah NM, Steinmetz MP. Identifying treatment patterns in patients with Bertolotti syndrome: an elusive cause of chronic low back pain. Spine J [Internet]. 2021 [cited 2025 Oct 15];21(9):1497–503. Available from: https://pubmed.ncbi.nlm.nih.gov/34010681/ Subscription required
4. McGrath K, Schmidt E, Rabah N, Abubakr M, Steinmetz M. Clinical assessment and management of Bertolotti Syndrome: a review of the literature. Spine J [Internet]. 2021 [cited 2025 Oct 15];21(8):1286–96. Available from: https://pubmed.ncbi.nlm.nih.gov/33676018/ Subscription required
5. Crane J, Cragon R, O’Neill J, Berger AA, Kassem H, Sherman WF, et al. A comprehensive update of the treatment and management of Bertolotti’s syndrome: a best practices review. Orthop Rev (Pavia) [Internet]. 2021 [cited 2025 Oct 15];13(2):24980. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567758/
6. Alonzo F, Cobar A, Cahueque M, Prieto JA. Bertolotti’s syndrome: an underdiagnosed cause for lower back pain. J Surg Case Rep [Internet]. 2018 [cited 2025 Oct 15];2018(10):rjy276. Available from: https://pubmed.ncbi.nlm.nih.gov/30356933/
7. Sahoo RK, Kar R, Patel R, Jadon A. Low back pain from Bertolotti’s syndrome: a not-so-uncommon aetiology. Indian J Anaesth [Internet]. 2020 [cited 2025 Oct 15];64(8):729-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457989/
8. Adams R, Herrera-Nicol S, Jenkins AL. Surgical treatment of a rare presentation of Bertolotti’s syndrome from Castellvi type IV lumbosacral transitional vertebra: case report and review of the literature. J Neurol Surg Rep [Internet]. 2018 [cited 2025 Oct 15];79(3):e70–4. Available from: https://pubmed.ncbi.nlm.nih.gov/30083494/
9. Golubovsky JL, Colbrunn RW, Klatte RS, Nagle TF, Briskin IN, Chakravarthy VB, et al. Development of a novel in vitro cadaveric model for analysis of biomechanics and surgical treatment of Bertolotti syndrome. Spine J [Internet]. 2020 [cited 2025 Oct 15];20(4):638–56. Available from: https://pubmed.ncbi.nlm.nih.gov/31669612/ Subscription required
10. Sumarriva G, Cook B, Celestre P. Surgical resection of Bertolotti syndrome. Ochsner J [Internet]. 2022 [cited 2025 Oct 15];22(1):76–9. Available from: https://pubmed.ncbi.nlm.nih.gov/35355636/
11. Vanelderen P, Szadek K, Cohen SP, De Witte J, Lataster A, Patijn J, et al. Sacroiliac joint pain. Pain Pract [Internet]. 2010 [cited 2025 Oct 15];10(5):470–8. Available from: https://pubmed.ncbi.nlm.nih.gov/20667026/ Subscription required
12. Visser LH, Nijssen PGN, Tijssen CC, van Middendorp JJ, Schieving J. Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis. Eur Spine J [Internet]. 2013 [cited 2025 Oct 15];22(7):1657–64. Available from: https://pubmed.ncbi.nlm.nih.gov/23455949/
13. Kennedy DJ, Engel A, Kreiner DS, Nampiaparampil D, Duszynski B, MacVicar J. Fluoroscopically guided diagnostic and therapeutic intra-articular sacroiliac joint injections: a systematic review. Pain Med [Internet]. 2015 [cited 2025 Oct 15];16(8):1500–18. Available from: https://pubmed.ncbi.nlm.nih.gov/26178855/ Subscription required
14. Szadek K, Cohen SP, de Andrés Ares J, Steegers M, van Zundert J, Kallewaard JW. Sacroiliac joint pain. Pain Pract [Internet]. 2024 [cited 2025 Oct 15];24(4):627–46. Available from: https://pubmed.ncbi.nlm.nih.gov/38155419/
15. Mikula AL, Lakomkin N, Ransom RC, Flanigan PM, Waksdahl LA, Pennington Z, et al. Operative treatment of Bertolotti syndrome: resection versus fusion. World Neurosurg [Internet]. 2022 [cited 2025 Oct 15];165:e311–6. Available from: https://pubmed.ncbi.nlm.nih.gov/35717016 Subscription required
