Bertolotti Syndrome in Children: 14 years of Experience in a Tertiary Center with a New Proposed Classification

Summary: The purpose of this study was to revisit the cases of low back pain in children, outline the cases with lumbosacral transitional vertebra (LSTV), review the children who required surgery and attempt to classify variants of LSTV in children. We identified various morphologic types of LSTV that have a distinct clinical pattern. The clinical significance and biomechanics of each has to be further studied to better understand the relationship between LSTV and low back pain in children.

Purpose: The purpose of this study was to revisit the cases of low back pain in children, outline the cases with lumbosacral transitional vertebra (LSTV), review the children who required surgery and attempt to classify variants of LSTV in children.

Methods: After IRB approval, we reviewed our database to identify cases of low back pain in children in our institution over the past 14 years and identified the cases with lumbo-sacral junction abnormalities, specifically LSTV. Cases of LSTV that were diagnosed following radiographic imaging were identified. Those requiring surgical intervention were separately documented. All radiographs and advanced imaging available were reviewed and features noted to identify distinct morphologic and clinical patterns. Based on the data a new classification is proposed.

Results: 2304 patients with preliminary diagnosis of low back pain were seen at CHOP over a 14-year period. Of these, 253 were randomly selected for detailed review. After imaging, 17 patients were identified with LSTV on plain radiographs. Three of these patients had sufficient persistent clinical symptoms that demanded surgical intervention and symptoms completely resolved following surgery. The classification system consists of 3 types and it is based on the morphologic and clinical features based on the origin of the pain. Type I alludes to pain from a stress fracture on a bony bar without an articulation. Type II involves pain from an abnormal bony bar articulation. Type III involves pain from an increased stress at the disc above the bony bar.

Conclusion: We have identified various morphologic types of LSTV that have a distinct clinical pattern. The clinical significance and biomechanics of each has to be further studied to better understand the relationship between LSTV and low back pain in children.