Bertolotti Syndrome Diagnosis

Tagged: Bertolotti Syndrome, L5/L6, LSTV, multiple surgeries, Pseudoarthrosis

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Brian McC
Participant

July 21, 2023 at 12:29 pm

Post count: 6

#35764

I was diagnosed with Bertolotti syndrome in 2008. I had a multi-level hybrid ADR L3/L4, L4/L5 and ALIF at L5/S1. After a couple of re-fusions and bi-lateral SIJ fusions I had a resection of BS pseudoarthrosis in 2011. Continuous back pain since then despite more surgery and a spinal chord stimulator implant. Recent revision SIJ si-bone fusion to fix a fracture in previous fusion in January this year. Still in lots of pain and now suspected re-growth of Bertolotti. My research/reading suggests BS is the cause but not all spine surgeons recognise BS as a pain generator. Due to have another discogram in 2 weeks time. My question is, can a discogram correctly identify Bertolotti as a possible pain generator please? I am concerned BS might be overlooked. Thank you

Donald Corenman, MD, DC
Moderator

July 23, 2023 at 12:45 pm

Post count: 8660

#35766

Your surgery goes way beyond Bertolotti’s syndrome, which is a sacralization of L5-S1 with a transverse/alar articulation that moves and causes pain (not common). The fusion of L5-S1 (if successful), would have stopped the pain generator. You have had artificial disc replacements (ADR) at L3-5, a revision for a pseudoarthrosis (I assume at L5-S1) and eventually bilateral fusions of your sacroiliac joints. Discograms are designed to determine if an intact disc (not surgically fused or replaced ADR) is a pain generator and your lower 3 discs have been removed. I would be highly auspicious that future surgery will help unless you have an obvious non-union or adjacent segment breakdown at L2-3. My impression is that you have a chronic pain syndrome (based upon very incomplete data) and you need a second (and even third) opinion before further surgery is contemplated.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Brian McC
Participant

July 24, 2023 at 8:21 am

Post count: 6

#35768

Thank you very much for your reply Doctor Corenman. With my layman’s limited knowledge, my thoughts were that it was BS that caused the damage back in 2008 to L3-S1 and to both SI joints. These were fixed as described with various success and subsequent revisions since. If the BS has re-grown, as it appears it has, could this have been the cause of the fracture in my right SI joint, recently re-fused by SI-Bone procedure. (same side as the BS). Since writing to you last week I now have pain in the area of this latest fusion. I am wondering if it could be the joint under stress again from the BS? I do now remember my very first discogram did show clearly the BS (and incidentally, spina bifida occult). My limited understanding of BS indicates there is a range of different types, some described as a ‘false joint’. Can a discogram be used to recreate provocative pain in BS?
I am a little confused how or why a discogram would be used when I have three levels without any discs to test.
Thank you for your thoughts.
Kind regards

Donald Corenman, MD, DC
Moderator

July 24, 2023 at 5:22 pm

Post count: 8660

#35769

Discograms would not be helpful to you as you have no discs below L2-3 to diagnose. Your pain could be from lack of fusion (pseudoarthrosis) and you would need a fine-cut CT scan to determine this. You could also have chronic nerve injury causing pain.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Brian McC
Participant

July 25, 2023 at 3:57 am

Post count: 6

#35770

Thank you for your comments Doctor Corenman. I will try to contact the surgeon and find out why a discogram and what he hopes to learn from it.
Kind regards

Brian McC
Participant

August 11, 2023 at 7:17 am

Post count: 6

#35780

I had the discogram/diagnostic intervertebral disc injection L2/3, L3/4 and L4/5 and injection to my left SIJ on Tuesday. It has revealed: L2/3 a ‘globally torn, severe concordant pain at low pressure, L3/4 severe concordant pain at opening pressure, L4/5 severe concordant pain at opening pressure.
L3/4 and L4/5 have Charite ADR but the exposed surfaces towards the back of each of the vertebra were tested resulting in the pain. I have been told that the Bertolotti at L5/S1 interbody is fused solid to my sacrum and is therefore not generating pain. I am confused by this because I was under the impression is was very likely the cause of all of my back problems originally and the reason why a resection was carried out some years ago, but has since regrown. I can’t understand why it is now no longer a problem if it is back to the situation it was before. Will it not place undue stresses on other joints even though L5/S1 is fused and my right SIJ now fused?
The treatment being considered and discussed is to fuse all levels from L4/L5 up to T10. In your opinion, do you think the BS should be resect again or is it best left as is?
I would welcome your opinion.
Kind regards
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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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